Individual
MS. JUDITH MARIE MEZZOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
14 SHERRY DRIVE, EAST HAMPTON, CT 06424-1016
(860) 267-9125
Mailing address
14 SHERRY DRIVE, EAST HAMPTON, CT 06424-1016
(860) 267-9125
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002663
CT
2255A2300X
Athletic Trainer
000010524
—
2255A2300X
Athletic Trainer
000273
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080002663CT02
BLUE CROSS BLUE SHIELD
CT
Enumeration date
08/02/2006
Last updated
04/05/2017
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