Healthcare Provider Details

I. General information

NPI: 1083520597
Provider Name (Legal Business Name): BRIGID BASORA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PARKER ST
MANCHESTER CT
06040-4417
US

IV. Provider business mailing address

5 PARKER ST
MANCHESTER CT
06040-4417
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-0564
  • Fax:
Mailing address:
  • Phone: 860-798-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number10.177450
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: