Provider Demographics
NPI:1528135605
Name:DEFLORIO, HEIDI SUZANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:SUZANNE
Last Name:DEFLORIO
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 1:16 JUDY LN
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1271
Mailing Address - Country:US
Mailing Address - Phone:413-525-8953
Mailing Address - Fax:
Practice Address - Street 1:1 CANAL RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-1921
Practice Address - Country:US
Practice Address - Phone:860-668-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist