Provider Demographics
NPI:1710037098
Name:CHIAIA, MARY BETH A (RPT)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:A
Last Name:CHIAIA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEGHAN LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1694
Mailing Address - Country:US
Mailing Address - Phone:203-926-9657
Mailing Address - Fax:
Practice Address - Street 1:636 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4408
Practice Address - Country:US
Practice Address - Phone:203-934-6690
Practice Address - Fax:203-934-6659
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002275OtherPT LICENSE