Provider Demographics
NPI:1982859369
Name:KALISZEWSKI, PATRICIA DIANA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIANA
Last Name:KALISZEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:LAPRADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 HURRY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-3108
Mailing Address - Country:US
Mailing Address - Phone:860-928-3644
Mailing Address - Fax:
Practice Address - Street 1:16 WINDSOR AVENUE
Practice Address - Street 2:VILLAGE MANOR
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1036
Practice Address - Country:US
Practice Address - Phone:860-564-4081
Practice Address - Fax:860-564-1472
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000875225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant