Provider Demographics
NPI:1265578256
Name:TACZLI, CORINNE E
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:E
Last Name:TACZLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:2049 SILAS DEANE HWY
Practice Address - Street 2:SUITE 1B
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2332
Practice Address - Country:US
Practice Address - Phone:860-953-0676
Practice Address - Fax:860-953-0682
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist