Provider Demographics
NPI:1881986693
Name:GOGLIETTINO, PATRICIA FREY (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:FREY
Last Name:GOGLIETTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1233
Mailing Address - Country:US
Mailing Address - Phone:203-426-1312
Mailing Address - Fax:
Practice Address - Street 1:13 PARK LAWN DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1043
Practice Address - Country:US
Practice Address - Phone:203-830-4180
Practice Address - Fax:203-797-2995
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist