Healthcare Provider Details

I. General information

NPI: 1992595482
Provider Name (Legal Business Name): BRIAN TABER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SAYBROOK RD
MIDDLETOWN CT
06457-4788
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3650
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007735
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: