Provider Demographics
NPI:1912286295
Name:LONGOBARDI HAGUE, MARIA ROSE (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSE
Last Name:LONGOBARDI HAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ROSE
Other - Last Name:LONGOBARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9 WASHINGTON AVE FL 1-A
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3267
Mailing Address - Country:US
Mailing Address - Phone:203-865-6784
Mailing Address - Fax:203-865-6788
Practice Address - Street 1:30 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3551
Practice Address - Country:US
Practice Address - Phone:203-878-0479
Practice Address - Fax:203-466-8527
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist