Provider Demographics
NPI:1851376867
Name:PRENETA, RICHARD JOSEPH JR (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:PRENETA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5657
Mailing Address - Country:US
Mailing Address - Phone:203-259-7177
Mailing Address - Fax:203-256-9217
Practice Address - Street 1:2119 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5657
Practice Address - Country:US
Practice Address - Phone:203-259-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080003438OtherBLUE CROSS BLUE SHIELD
CT650000429Medicare PIN