Provider Demographics
NPI:1134237043
Name:LACOE, CHRISTINA DAMARIS (PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DAMARIS
Last Name:LACOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2B LEE RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351-3042
Mailing Address - Country:US
Mailing Address - Phone:860-376-2564
Mailing Address - Fax:860-376-4812
Practice Address - Street 1:165 HARTFORD PIKE
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-0425
Practice Address - Country:US
Practice Address - Phone:860-779-0150
Practice Address - Fax:860-774-2371
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004217437Medicaid
CT080007010CT01OtherBCBS
CT650000666Medicare PIN