Healthcare Provider Details

I. General information

NPI: 1770685695
Provider Name (Legal Business Name): MRS. GRETCHEN BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GRETCHEN BECKER

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 TOMPKINS ST
WATERBURY CT
06708-1417
US

IV. Provider business mailing address

175 BRENTWOOD DR
CHESHIRE CT
06410-3425
US

V. Phone/Fax

Practice location:
  • Phone: 203-419-0381
  • Fax: 203-419-0389
Mailing address:
  • Phone: 203-271-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: