Provider Demographics
NPI:1134173693
Name:SILEO, KATHLEEN M (RPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:SILEO
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 1:245 ALVORD PARK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790
Mailing Address - Country:US
Mailing Address - Phone:860-482-3539
Mailing Address - Fax:860-482-0258
Practice Address - Street 1:245 ALVORD PARK ROAD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-482-3539
Practice Address - Fax:860-482-0258
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2693229OtherAETNA
CT080003994CT08OtherBC
CT2693229OtherAETNA