Provider Demographics
NPI:1720186034
Name:GUALDRON, EDILIA (DPT)
Entity Type:Individual
Prefix:DR
First Name:EDILIA
Middle Name:
Last Name:GUALDRON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FEDERAL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2418
Mailing Address - Country:US
Mailing Address - Phone:203-775-5555
Mailing Address - Fax:203-775-0782
Practice Address - Street 1:304 FEDERAL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2418
Practice Address - Country:US
Practice Address - Phone:203-775-5555
Practice Address - Fax:203-775-0782
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080005928CT01OtherANTHEM