Healthcare Provider Details

I. General information

NPI: 1215332481
Provider Name (Legal Business Name): GUNILLA ABENA OBESEBEA DAAKU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

504 FOUNTAIN ST APT C2
NEW HAVEN CT
06515-1843
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-2934
  • Fax:
Mailing address:
  • Phone: 269-487-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10301
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: