Provider Demographics
NPI:1922209147
Name:CONSTANTINE, KAREN (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CONSTANTINE
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 1:33 HOSPITAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6007
Mailing Address - Country:US
Mailing Address - Phone:203-792-5558
Mailing Address - Fax:203-791-3213
Practice Address - Street 1:33 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6007
Practice Address - Country:US
Practice Address - Phone:203-792-5558
Practice Address - Fax:203-791-3213
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CT005952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5952OtherLICENSE#
CTD400004104Medicare PIN