Provider Demographics
NPI:1285971168
Name:MUNSON, ELAINE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FREEDOM WAY UNIT B2
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1041
Mailing Address - Country:US
Mailing Address - Phone:860-691-8960
Mailing Address - Fax:860-691-8969
Practice Address - Street 1:11 FREEDOM WAY UNIT B2
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1041
Practice Address - Country:US
Practice Address - Phone:860-691-8960
Practice Address - Fax:860-691-8969
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist