Provider Demographics
NPI:1962691196
Name:DONOFRIO, MARCIA A (PT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:DONOFRIO
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 1:175 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1441
Mailing Address - Country:US
Mailing Address - Phone:860-456-8869
Mailing Address - Fax:860-450-1936
Practice Address - Street 1:175 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1441
Practice Address - Country:US
Practice Address - Phone:860-456-8869
Practice Address - Fax:860-450-1936
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0116301OtherORTHONET-HEALTHNET
CT056002OtherHEALTH NET
CTANC895OtherOXFORD
CT080001450CT02OtherBLUE CROSS BLUE SHIELD
0116301OtherORTHONET-HEALTHNET