| NPI | 1972500304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M DEMING Credentialing Coding Manager 860-549-8276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2018-10-15 |