Healthcare Provider Details

I. General information

NPI: 1023072345
Provider Name (Legal Business Name): CRAIG R DENEGAR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHYSICAL THERAPY 358 MANSFIELD ROAD, UNIT 2101
STORRS MANSFIELD CT
06269-2101
US

IV. Provider business mailing address

PHYSICAL THERAPY 358 MANSFIELD ROAD, UNIT 2101
STORRS CT
06269-2101
US

V. Phone/Fax

Practice location:
  • Phone: 860-486-0052
  • Fax: 860-486-1158
Mailing address:
  • Phone: 860-486-0052
  • Fax: 860-486-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007701L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: