Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 005773 | CT |
NPI | 1235348889 |
---|---|
Provider Name | Ms. Carol Ann Peters |
First Address | East Hampton, CT 06424-1534 |
Second Address | Middletown, CT 06457-4063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |