Provider Demographics
NPI:1871508424
Name:FALCO HAYDON, PAMELA ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:FALCO HAYDON
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 1:14 JONES HOLLOW RD STE 7
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1448
Mailing Address - Country:US
Mailing Address - Phone:860-295-8188
Mailing Address - Fax:860-295-8976
Practice Address - Street 1:14 JONES HOLLOW RD STE 7
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1448
Practice Address - Country:US
Practice Address - Phone:860-295-8188
Practice Address - Fax:860-295-8976
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004111572Medicaid
CT080002102CT01OtherBLUE CROSS BLUE SHEILD
CT650000704Medicare PIN