Healthcare Provider Details

I. General information

NPI: 1770714495
Provider Name (Legal Business Name): SANGEETA KOTIAN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OLD KINGS HWY S SUITE 110
DARIEN CT
06820-4552
US

IV. Provider business mailing address

1536 3RD AVE 5TH FLOOR
NEW YORK NY
10028-2167
US

V. Phone/Fax

Practice location:
  • Phone: 203-202-9889
  • Fax:
Mailing address:
  • Phone: 212-861-2630
  • Fax: 212-861-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008006
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: