Provider Demographics
NPI:1184738197
Name:GIORDANO, CHARLES S (PTMS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:GIORDANO
Suffix:
Gender:M
Credentials:PTMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 COPPS HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4050
Mailing Address - Country:US
Mailing Address - Phone:203-438-1898
Mailing Address - Fax:203-438-1864
Practice Address - Street 1:63 COPPS HILL RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4050
Practice Address - Country:US
Practice Address - Phone:203-438-1898
Practice Address - Fax:203-438-1864
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000969Medicare ID - Type Unspecified