Healthcare Provider Details

I. General information

NPI: 1821645300
Provider Name (Legal Business Name): OLGA SINNEMA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLGA TERESHCHUK DPT

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MOUNTAIN ROAD
SUFFIELD CT
06078
US

IV. Provider business mailing address

435 HARTFORD TPKE STE U
VERNON CT
06066-4834
US

V. Phone/Fax

Practice location:
  • Phone: 860-668-9589
  • Fax: 860-668-9802
Mailing address:
  • Phone: 860-979-1611
  • Fax: 860-263-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012328
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: