Healthcare Provider Details

I. General information

NPI: 1518881473
Provider Name (Legal Business Name): DHIMITRI STOJKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2543 DIXWELL AVE
HAMDEN CT
06514-1860
US

IV. Provider business mailing address

2543 DIXWELL AVE
HAMDEN CT
06514-1860
US

V. Phone/Fax

Practice location:
  • Phone: 203-457-8624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031632
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: