Provider Demographics
NPI:1790089597
Name:ANGELFISH THERAPY
Entity Type:Organization
Organization Name:ANGELFISH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AILENE
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:TISSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-545-0024
Mailing Address - Street 1:168 INTERVALE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1311
Mailing Address - Country:US
Mailing Address - Phone:203-545-0024
Mailing Address - Fax:203-968-1484
Practice Address - Street 1:168 INTERVALE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1311
Practice Address - Country:US
Practice Address - Phone:203-545-0024
Practice Address - Fax:203-968-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty