Healthcare Provider Details

I. General information

NPI: 1366439424
Provider Name (Legal Business Name): KATHLEEN ANN DOYLE RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUMMIT RD
PROSPECT CT
06712-1485
US

IV. Provider business mailing address

PO BOX 7261
PROSPECT CT
06712-0261
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-4278
  • Fax: 203-758-3617
Mailing address:
  • Phone: 203-758-4278
  • Fax: 203-758-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001434
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: