Healthcare Provider Details

I. General information

NPI: 1265955132
Provider Name (Legal Business Name): LAURA ANN LITWIN ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CROSS ST
MIDDLETOWN CT
06459-3213
US

IV. Provider business mailing address

161 CROSS ST
MIDDLETOWN CT
06459-3213
US

V. Phone/Fax

Practice location:
  • Phone: 860-685-3980
  • Fax:
Mailing address:
  • Phone: 860-685-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number000860
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000860
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: