Provider Demographics
NPI:1598715054
Name:GRASSO, MICHELE (RPT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GRASSO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-0619
Mailing Address - Country:US
Mailing Address - Phone:860-345-2622
Mailing Address - Fax:860-345-2626
Practice Address - Street 1:3A CANDLEWOOD HILL ROAD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4202
Practice Address - Country:US
Practice Address - Phone:860-345-2622
Practice Address - Fax:860-345-2626
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080004600CT03OtherANTHEM BC/BS
CT004145480Medicaid
CT5360125OtherAETNA
CT68562OtherOXFORD/ORTHONET
CT15701OtherCIGNA/ORTHONET
CT68562OtherOXFORD/ORTHONET
CTP00210403Medicare PIN
CTDD1387Medicare ID - Type UnspecifiedRAILIROAD GROUP NUMBER
CT080004600CT03OtherANTHEM BC/BS
CT650000260Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE