Provider Demographics
NPI:1902141120
Name:SILPOT, AJAUNIE DEAGO (PTA)
Entity Type:Individual
Prefix:
First Name:AJAUNIE
Middle Name:DEAGO
Last Name:SILPOT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FOREST ST APT 1107
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1871
Mailing Address - Country:US
Mailing Address - Phone:203-550-2384
Mailing Address - Fax:
Practice Address - Street 1:650 WEST AVE
Practice Address - Street 2:INNOVATIVE HEALTH AND REHABILITATION
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4020
Practice Address - Country:US
Practice Address - Phone:203-852-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1291225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant