Provider Demographics
NPI:1255386892
Name:SPECTOR, MAREDITH E (PT)
Entity type:Individual
Prefix:MS
First Name:MAREDITH
Middle Name:E
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:20 GERMANTOWN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5023
Practice Address - Country:US
Practice Address - Phone:203-798-6523
Practice Address - Fax:203-798-0393
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT003200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080003200CT01OtherANTHEM BC RIDGEFIELD
CT080003200CT04OtherANTHEM BC-DANBURY