1306310768 NPI number — ARETI FILIPPIDIS LAT, ATC

Table of content: KATELYN MAE BIHM (NPI 1619676897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306310768 NPI number — ARETI FILIPPIDIS LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FILIPPIDIS
Provider First Name:
ARETI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
F

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:
1306310768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 PONUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06850-1937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-604-4541
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 MEMORIAL DR STE 10313
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULLOWHEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28723-8911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-604-4541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: 1672 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 97040326804 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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