Healthcare Provider Details

I. General information

NPI: 1609056936
Provider Name (Legal Business Name): 11:11 PRODUCTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MAIN ST S C/O HOLISTIC HEALTH CENTER
SOUTHBURY CT
06488-2275
US

IV. Provider business mailing address

220 MAIN ST S C/O HOLISTIC HEALTH CENTER
SOUTHBURY CT
06488-2275
US

V. Phone/Fax

Practice location:
  • Phone: 203-264-6624
  • Fax: 203-267-6642
Mailing address:
  • Phone: 203-264-6624
  • Fax: 203-267-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000036
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number003704
License Number StateCT

VIII. Authorized Official

Name: EMILIE CONNOR
Title or Position: PRESIDENT
Credential: P.T., L.AC.
Phone: 203-264-6624