Provider Demographics
NPI:1922433960
Name:ANDRES, MELCHORA KATHY SANTOS (RPT)
Entity Type:Individual
Prefix:MISS
First Name:MELCHORA KATHY
Middle Name:SANTOS
Last Name:ANDRES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WEID DR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4764
Mailing Address - Country:US
Mailing Address - Phone:203-729-9889
Mailing Address - Fax:
Practice Address - Street 1:89 WEID DR
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4764
Practice Address - Country:US
Practice Address - Phone:203-729-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist