Provider Demographics
NPI:1790728426
Name:DRANSFIELD, MARY LISA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY LISA
Middle Name:
Last Name:DRANSFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SAND PIT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-748-5631
Mailing Address - Fax:203-207-3194
Practice Address - Street 1:96 ROUTE 37
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812
Practice Address - Country:US
Practice Address - Phone:203-312-0211
Practice Address - Fax:203-312-0201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004252417Medicaid