Provider Demographics
NPI:1770853822
Name:BOSCOLO, RHEA JANE (PT)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:JANE
Last Name:BOSCOLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:RHEA
Other - Middle Name:JANE
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:117 STOCKING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3429
Mailing Address - Country:US
Mailing Address - Phone:860-828-9637
Mailing Address - Fax:
Practice Address - Street 1:333 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1561
Practice Address - Country:US
Practice Address - Phone:860-342-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist