Provider Demographics
NPI:1396731873
Name:VIENTOS, MARY BETH J (RPT)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:J
Last Name:VIENTOS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:MARY BETH
Other - Middle Name:J
Other - Last Name:CHIARELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:101 N PLAINS INDUSTRIAL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2360
Mailing Address - Country:US
Mailing Address - Phone:203-265-0018
Mailing Address - Fax:203-265-4368
Practice Address - Street 1:101 N PLAINS INDUSTRIAL RD
Practice Address - Street 2:STE 100
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2360
Practice Address - Country:US
Practice Address - Phone:203-265-0018
Practice Address - Fax:203-265-4368
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist