Provider Demographics
NPI:1831478015
Name:PECCHIA, BRIAN MICHAEL (DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:PECCHIA
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3339
Mailing Address - Country:US
Mailing Address - Phone:860-979-1600
Mailing Address - Fax:
Practice Address - Street 1:5151 PARK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1090
Practice Address - Country:US
Practice Address - Phone:203-396-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist