Provider Demographics
NPI:1194786236
Name:DICARLO, RICHARD T (RPT, CHT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:T
Last Name:DICARLO
Suffix:
Gender:M
Credentials:RPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-294-6734
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:203-865-6788
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061152251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400154689Medicare PIN