Provider Demographics
NPI:1891865036
Name:CALVANESE, THOMAS L (RPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:CALVANESE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MACINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1358
Mailing Address - Country:US
Mailing Address - Phone:203-881-0602
Mailing Address - Fax:203-373-1271
Practice Address - Street 1:3180 MAIN ST STE G2
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4237
Practice Address - Country:US
Practice Address - Phone:203-372-9879
Practice Address - Fax:203-373-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist