Provider Demographics
NPI:1972734473
Name:BOSCARINO, LAURI F
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:F
Last Name:BOSCARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 EASTERN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4382
Mailing Address - Country:US
Mailing Address - Phone:860-633-1016
Mailing Address - Fax:860-875-6423
Practice Address - Street 1:84 SNIPSIC LAKE RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3519
Practice Address - Country:US
Practice Address - Phone:860-633-1016
Practice Address - Fax:860-875-6423
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0033052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics