Provider Demographics
NPI:1922385251
Name:DELAURENTIS, SUSAN (RPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:DELAURENTIS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 SUMMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1850
Mailing Address - Country:US
Mailing Address - Phone:203-421-3490
Mailing Address - Fax:
Practice Address - Street 1:1775 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1643
Practice Address - Country:US
Practice Address - Phone:860-399-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist