Healthcare Provider Details

I. General information

NPI: 1699793463
Provider Name (Legal Business Name): ELIZABETH L BRONNER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH L GALANTI PT

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SALMON BROOK ST
GRANBY CT
06035-2607
US

IV. Provider business mailing address

97 SALMON BROOK ST
GRANBY CT
06035-2607
US

V. Phone/Fax

Practice location:
  • Phone: 860-844-8912
  • Fax: 860-844-8912
Mailing address:
  • Phone: 860-844-8912
  • Fax: 860-844-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19529
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7603
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: