Provider Demographics
NPI:1700514684
Name:KELLEHER, ELENA (DPT)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:MASIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1926
Mailing Address - Country:US
Mailing Address - Phone:860-409-4595
Mailing Address - Fax:
Practice Address - Street 1:860 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2449
Practice Address - Country:US
Practice Address - Phone:203-793-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist