Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 3430 | CT |
N | 2251E1200X | Ergonomics | 3430 | CT |
N | 225XE1200X | Ergonomics | 3430 | CT |
N | 2251G0304X | Physical Therapist - Geriatrics | 3430 | CT |
N | 2251S0007X | Physical Therapist - Sports | 3430 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 3430 | CT |
NPI | 1255476313 |
---|---|
Provider Name | Robert J Mastrianni |
First Address | Wallingford, CT 06492-1929 |
Second Address | Wallingford, CT 06492-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080003430CT13 | ANTHEM BCBS (01) | CT |
0V1691 | HEALTHNET (01) | CT |
1182831 | AETNA (01) | CT |
183158 | FIRST CHOICE (01) | CT |
6404254 | UNITED HEALTHCARE (01) | CT |
712712 | CONNECTICARE (01) | CT |
A667399 | OXFORD (01) | CT |