Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 010210 | CT |
N | 2251G0304X | Physical Therapist - Geriatrics | 010210 | CT |
N | 2251H1200X | Hand | 010210 | CT |
N | 2251N0400X | Physical Therapist - Neurology | 010210 | CT |
N | 2251S0007X | Physical Therapist - Sports | 010210 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 010210 | CT |
NPI | 1821498932 |
---|---|
Provider Name | Mr. Kyle J. Dorosh |
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 | 26/08/2014 |
Last Update Date | 26/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0036401 | CIGNA HEALTHCARE (01) | CT |
015353 | CONNECTICARE INC. (01) | CT |
119457 | AETNA (01) | CT |
ANC1648 | OXFORD HEALTH CARE (01) | CT |