Facts
- Status
- A
- Credential
- DPT
- Type
- Individual
- Enumeration date
- 2023-08-09
- Last updated
- 2023-08-09
Specialties
Licenses
- License CT
- 14086
Location
- Practice location
- 230 MOUNTAIN ROAD, 2ND FLOOR
- City
- SUFFIELD CT
- Postal code
- 06078
- Phone
- 860-668-9589
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.