Provider Demographics
NPI:1730284381
Name:DALY, ANN MARIE (RPT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:DALY
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 1:1320 WEST MAIN ST
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9355
Mailing Address - Fax:203-597-8192
Practice Address - Street 1:1320 WEST MAIN ST
Practice Address - Street 2:BLDG 2
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9355
Practice Address - Fax:203-597-8192
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
24801OtherCIGNA ORTHONET
0024801OtherHEALTH NET ORTHONET
ANC758OtherOXFORD
080002917CT01OtherANTHEM BCBS OF CT
0V1830OtherHEALTH NET
6248766001OtherCIGNA
004383OtherAETNA US HEALTH CARE
ANC758OtherOXFORD