Provider Demographics
NPI:1669551024
Name:RISIGO, ANGELA ST LOUIS (PT)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:ST LOUIS
Last Name:RISIGO
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 1:15 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1878
Mailing Address - Country:US
Mailing Address - Phone:860-268-3226
Mailing Address - Fax:860-499-5356
Practice Address - Street 1:744 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2307
Practice Address - Country:US
Practice Address - Phone:860-365-5514
Practice Address - Fax:860-499-5356
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4130225100000X
CT006488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist