Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 006164 | CT |
N | 2251N0400X | Physical Therapist - Neurology | 006164 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 006164 | CT |
NPI | 1386815843 |
---|---|
Provider Name | Mr. Kevin Pratt |
First Address | Islandia, NY 11749-5258 |
Second Address | Wallingford, CT 06492-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2008 |
Last Update Date | 04/02/2021 |