Healthcare Provider Details

I. General information

NPI: 1720342579
Provider Name (Legal Business Name): MICHAEL ANTHONY UZAR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MAIN ST
CROMWELL CT
06416-2308
US

IV. Provider business mailing address

150 POQUONOCK AVE
WINDSOR CT
06095-2429
US

V. Phone/Fax

Practice location:
  • Phone: 860-365-5613
  • Fax:
Mailing address:
  • Phone: 860-688-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011042
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: