Provider Demographics
NPI:1386887495
Name:DURKEE, MISTY M (PT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:DURKEE
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 1:181 PATRICIA M. GENOVA DRIVE
Mailing Address - Street 2:EASTERN REHABILITATION NETWORK 5TH FLOOR
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-667-5480
Mailing Address - Fax:860-667-8416
Practice Address - Street 1:1064 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-235-9622
Practice Address - Fax:203-630-3600
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004212362Medicaid
CT076536OtherMEDICARE