Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 000064 | CT |
NPI | 1013290915 |
---|---|
Provider Name | Lisa Michele Breton |
First Address | Waterbury, CT 06704-2326 |
Second Address | Watertown, CT 06795-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2011 |
Last Update Date | 27/09/2011 |