Healthcare Provider Details

I. General information

NPI: 1629900709
Provider Name (Legal Business Name): SENEN JOAQUIN ANTUNEZ-TIERNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 N MAIN STREET EXT
WALLINGFORD CT
06492-2449
US

IV. Provider business mailing address

47 N MAIN ST
WEST HARTFORD CT
06107-1926
US

V. Phone/Fax

Practice location:
  • Phone: 203-793-7592
  • Fax: 203-793-7397
Mailing address:
  • Phone: 860-409-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15434
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: