Healthcare Provider Details

I. General information

NPI: 1851403356
Provider Name (Legal Business Name): JOANNE M SANBORN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAMILTON RD MEDICAL DEPARTMENT, MS 1-1-BC38
WINDSOR LOCKS CT
06096-1000
US

IV. Provider business mailing address

38 ROCKLEDGE DR
SOUTH WINDSOR CT
06074-1568
US

V. Phone/Fax

Practice location:
  • Phone: 860-654-2503
  • Fax: 860-654-5816
Mailing address:
  • Phone: 860-644-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002419
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: