Provider Demographics
NPI:1770601320
Name:RICHETELLI, DENNIS CHRISTOPHER (ATC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:CHRISTOPHER
Last Name:RICHETELLI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HOUSATONIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3416
Mailing Address - Country:US
Mailing Address - Phone:203-878-5336
Mailing Address - Fax:
Practice Address - Street 1:24 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4424
Practice Address - Country:US
Practice Address - Phone:203-563-0610
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
CT0003602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000360OtherSTATE LICENSURE