Healthcare Provider Details

I. General information

NPI: 1053374348
Provider Name (Legal Business Name): CAROL HAHN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SPENCER ST
WINSTED CT
06098
US

IV. Provider business mailing address

155 E WAKEFIELD BLVD
WINSTED CT
06098-2976
US

V. Phone/Fax

Practice location:
  • Phone: 860-559-0747
  • Fax: 860-738-9395
Mailing address:
  • Phone: 860-559-0747
  • Fax: 860-238-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2305208613
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305208613
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11050
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005714
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: