Provider Demographics
NPI:1134377039
Name:LOMBARDO, CARRIE (RPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PHEDON PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2421
Mailing Address - Country:US
Mailing Address - Phone:860-343-0057
Mailing Address - Fax:
Practice Address - Street 1:85 BARNES RD STE 109
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1832
Practice Address - Country:US
Practice Address - Phone:203-697-1067
Practice Address - Fax:203-284-0492
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist