=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083444194
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIF ERIK ARONSEN DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2024
-----------------------------------------------------
Last Update Date | 08/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 HARTFORD TPKE STE S
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06066-5042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-870-0760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 TRAIL RUN APT 9110
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06066-3988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-645-6509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 14556
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------