Provider Demographics
NPI:1770038259
Name:PANNESE, ASHLEY LINDA (DPT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LINDA
Last Name:PANNESE
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 1:10 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2750
Mailing Address - Country:US
Mailing Address - Phone:203-258-3155
Mailing Address - Fax:
Practice Address - Street 1:10 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-2750
Practice Address - Country:US
Practice Address - Phone:203-258-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist