Provider Demographics
NPI:1124123948
Name:RIFKIN, CARMELITA VIEGA (PT MS CLTLANA)
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:VIEGA
Last Name:RIFKIN
Suffix:
Gender:F
Credentials:PT MS CLTLANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOLLEY LANE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712
Mailing Address - Country:US
Mailing Address - Phone:203-758-6569
Mailing Address - Fax:203-758-0443
Practice Address - Street 1:93 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712
Practice Address - Country:US
Practice Address - Phone:203-758-6569
Practice Address - Fax:203-758-0443
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
080002286CT01OtherANTHEM