Provider Demographics
NPI:1720106065
Name:BARENHOLTZ, THEODORA ANN (RPT, MS, RYT)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:ANN
Last Name:BARENHOLTZ
Suffix:
Gender:F
Credentials:RPT, MS, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1056
Mailing Address - Country:US
Mailing Address - Phone:203-254-1311
Mailing Address - Fax:
Practice Address - Street 1:325 REEF RD
Practice Address - Street 2:SUITE 209
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6537
Practice Address - Country:US
Practice Address - Phone:203-400-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist