Provider Demographics
NPI:1922450907
Name:BERTONI, THOMAS E (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BERTONI
Suffix:
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 1:140 MILL ST APT 1394
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1080
Mailing Address - Country:US
Mailing Address - Phone:203-913-6420
Mailing Address - Fax:
Practice Address - Street 1:140 MILL ST APT 1394
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-1080
Practice Address - Country:US
Practice Address - Phone:203-913-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist