Provider Demographics
NPI:1538598933
Name:LUSSIER, MICHELLE GAYE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GAYE
Last Name:LUSSIER
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 1:188 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8035
Mailing Address - Country:US
Mailing Address - Phone:860-334-1736
Mailing Address - Fax:
Practice Address - Street 1:2B LEE RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-3042
Practice Address - Country:US
Practice Address - Phone:860-376-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004353225100000X
RI0909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist