Provider Demographics
NPI:1225029614
Name:CHESLOG, CURT IRA (PT, MSPT, OCS)
Entity type:Individual
Prefix:MR
First Name:CURT
Middle Name:IRA
Last Name:CHESLOG
Suffix:
Gender:M
Credentials:PT, MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STONINGTON RD
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2965
Mailing Address - Country:US
Mailing Address - Phone:860-536-1699
Mailing Address - Fax:860-536-1686
Practice Address - Street 1:80 STONINGTON RD
Practice Address - Street 2:SUITE A-3
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2965
Practice Address - Country:US
Practice Address - Phone:860-536-1699
Practice Address - Fax:860-536-1686
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN