Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9536 | CT |
N | 2251G0304X | Physical Therapist - Geriatrics | 9536 | CT |
N | 2251N0400X | Physical Therapist - Neurology | 9536 | CT |
N | 2251S0007X | Physical Therapist - Sports | 9536 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 9536 | CT |
NPI | 1053661785 |
---|---|
Provider Name | Mr. Bryan M Mehigen |
First Address | Rocky Hill, CT 06067-1851 |
Second Address | Rocky Hill, CT 06067-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 10/09/2012 |