Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 0077350 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | PT01926 | RI |
NPI | 1013049717 |
---|---|
Provider Name | Mr. Edmond Francis Cardinal JR. |
First Address | Mystic, CT 06355-3641 |
Second Address | Mystic, CT 06355-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |