Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 002142 | CT |
NPI | 1104090414 |
---|---|
Provider Name | Ms. Patricia Ann Gromoshak |
First Address | Waterbury, CT 06705 |
Second Address | Farmington, CT 06032-2257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |