Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 12491 | CT |
NPI | 1306477286 |
---|---|
Provider Name | Stephen M. Peszynski |
First Address | Manchester, CT 06042-8924 |
Second Address | Manchester, CT 06040-4738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2020 |
Last Update Date | 30/01/2020 |