Provider Demographics
NPI:1780155069
Name:ALFANO, KATHLEEN LORRAINE (PTA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LORRAINE
Last Name:ALFANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:LORRAINE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:15 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1512
Mailing Address - Country:US
Mailing Address - Phone:386-299-0226
Mailing Address - Fax:
Practice Address - Street 1:15 HICKORY HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1512
Practice Address - Country:US
Practice Address - Phone:386-299-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1272225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1272OtherPHYSICAL THERAPY