Healthcare Provider Details

I. General information

NPI: 1013647346
Provider Name (Legal Business Name): SAUL VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 OSBORNE ST
DANBURY CT
06810-6016
US

IV. Provider business mailing address

1 UNION AVE UNIT 16
DANBURY CT
06810-5975
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-8102
  • Fax:
Mailing address:
  • Phone: 860-778-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000772
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: