Healthcare Provider Details

I. General information

NPI: 1346388584
Provider Name (Legal Business Name): STEVE GWARA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 PATRICIA GENOVA DRIVE EASTERN REHABILITATION NETWORK (5TH FLOOR)
NEWINGTON CT
06111
US

IV. Provider business mailing address

181 PATRICIA GENOVA DRIVE EASTERN REHABILITATION NETWORK (5TH FLOOR)
NEWINGTON CT
06111
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-5480
  • Fax: 860-667-8416
Mailing address:
  • Phone: 860-667-5480
  • Fax: 860-667-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number672
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: