Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 2305208613 | VA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 005714 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 11050 | MA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305208613 | VA |
NPI | 1053374348 |
---|---|
Provider Name | Carol Hahn |
First Address | Winsted, CT 06098-2976 |
Second Address | Winsted, CT 06098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2006 |
Last Update Date | 20/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080005714 | BCBS PROVIDER ID (01) | CT |
Y67757 | BCBS PROVIDER ID (01) | MA |