Provider Demographics
NPI:1871679860
Name:PASSANTE, REBECCA MCHENRY (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MCHENRY
Last Name:PASSANTE
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 1:27 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2601
Mailing Address - Country:US
Mailing Address - Phone:860-274-4092
Mailing Address - Fax:860-274-4099
Practice Address - Street 1:385 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2003
Practice Address - Country:US
Practice Address - Phone:203-453-2844
Practice Address - Fax:203-453-8772
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080005105CT24OtherANTHEM BC BS
CT080005105CT21OtherANTHEM BC BS
CT080005105CT25OtherANTHEM BC BS