Healthcare Provider Details

I. General information

NPI: 1386861201
Provider Name (Legal Business Name): ROBERT JOHN FRIEDBERG RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HIGHLAND ST
WEST HARTFORD CT
06119-1324
US

IV. Provider business mailing address

11 WESTRIDGE DR
SIMSBURY CT
06070-2923
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-5623
  • Fax:
Mailing address:
  • Phone: 860-651-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number006053
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: