Provider Demographics
NPI:1699720474
Name:PUZZO, MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PUZZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BUSSIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:200 MERROW RD
Practice Address - Street 2:UNIT 2
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3416
Practice Address - Country:US
Practice Address - Phone:860-872-8357
Practice Address - Fax:860-872-8397
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004203577Medicaid
CT2V8093OtherHEALTHNET
CT080006545CTOtherANTHEM BC
CT004203577Medicaid