Provider Demographics
NPI:1194491464
Name:INSERILLO, PETER JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:INSERILLO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 STEELE RD APT 312A
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1725
Mailing Address - Country:US
Mailing Address - Phone:860-816-4697
Mailing Address - Fax:860-674-1095
Practice Address - Street 1:635 NEW PARK AVE # 2-A3
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1329
Practice Address - Country:US
Practice Address - Phone:860-816-4697
Practice Address - Fax:860-674-1095
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.013235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist