Provider Demographics
NPI:1821208539
Name:DALENA, MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:DALENA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PECK ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2152
Mailing Address - Country:US
Mailing Address - Phone:860-828-1373
Mailing Address - Fax:
Practice Address - Street 1:60 WEST ST
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3518
Practice Address - Country:US
Practice Address - Phone:860-529-2521
Practice Address - Fax:860-563-2640
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000127225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant