1790393254 NPI number — VERTIGO & BALANCE RECOVERY LLC

Table of content: MARCIA ANNE CATLETT LCPC, LPC, MA, MED (NPI 1053457044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790393254 NPI number — VERTIGO & BALANCE RECOVERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERTIGO & BALANCE RECOVERY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790393254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 TAYLOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06812-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-512-3611
Provider Business Mailing Address Fax Number:
203-549-0613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6527 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-1385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-512-3611
Provider Business Practice Location Address Fax Number:
203-549-0613
Provider Enumeration Date:
07/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DRANSFIELD
Authorized Official First Name:
MARY LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
203-512-3611

Provider Taxonomy Codes

  • Taxonomy code: 2251N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com