Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 12339 | CT |
NPI | 1356001713 |
---|---|
Provider Name | Jonathan Maneen |
First Address | Berlin, CT 06037-1659 |
Second Address | Berlin, CT 06037-1659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2021 |
Last Update Date | 28/12/2021 |