Provider Demographics
NPI:1720055239
Name:MAIORINO, MICHELLE M (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:MAIORINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1128
Mailing Address - Country:US
Mailing Address - Phone:860-537-6798
Mailing Address - Fax:860-531-3224
Practice Address - Street 1:7 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1128
Practice Address - Country:US
Practice Address - Phone:860-531-3222
Practice Address - Fax:860-531-3224
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist