Provider Demographics
NPI:1972503662
Name:LICHTFUS, TODD (MS, PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:LICHTFUS
Suffix:
Gender:M
Credentials:MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2207
Mailing Address - Country:US
Mailing Address - Phone:203-239-4274
Mailing Address - Fax:203-239-4290
Practice Address - Street 1:202 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2207
Practice Address - Country:US
Practice Address - Phone:203-239-4274
Practice Address - Fax:203-239-4290
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004239746Medicaid
CT650001000Medicare PIN