Provider Demographics
NPI:1134216872
Name:COUTURE, ELIZABETH M (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:COUTURE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PUNKUP RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1750
Mailing Address - Country:US
Mailing Address - Phone:203-888-4303
Mailing Address - Fax:
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 121
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-755-5555
Practice Address - Fax:203-597-6391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080001818CT07OtherANTHEM BLUE CROSS BLUE SHIELD
CT080001818CT07OtherANTHEM BLUE CROSS BLUE SHIELD
CT650001484Medicare PIN