Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 007742 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 5831 | AZ |
NPI | 1073585386 |
---|---|
Provider Name | John D Bianchini |
First Address | Prospect, CT 06712-0205 |
Second Address | Prospect, CT 06712-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 14/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080007742CT01 | ANTHEM BC BS (01) | CT |
080007742CT02 | ANTHEM BC BS (01) | CT |
080007742CT06 | ANTHEM BCBS (01) | CT |