Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 002762 | CT |
NPI | 1073536868 |
---|---|
Provider Name | Mr. Lawrence Ross |
First Address | Norwalk, CT 06851-5711 |
Second Address | Norwalk, CT 06851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 19/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18901 | CIGNA/ORTHONET ID NUMBER (01) | CT |
2019893 | AETNA ID NUMBER (01) | CT |
50RPTINC0CT01 | BLUE CROSS BLUE SHIELD NU (01) | CT |
764202 | CONNECTICARE ID NUMBER (01) | CT |
ANC1685 | OXFORD ID NUMBER (01) | CT |