Healthcare Provider Details

I. General information

NPI: 1447363072
Provider Name (Legal Business Name): MRS. SHEILA REIMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 E HYERDALE DR
GOSHEN CT
06756-1918
US

IV. Provider business mailing address

356 E HYERDALE DR
GOSHEN CT
06756-1918
US

V. Phone/Fax

Practice location:
  • Phone: 860-491-3725
  • Fax:
Mailing address:
  • Phone: 860-491-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007501
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number004661-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: