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General NPI Number Information
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NPI Number | 1104090414
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Entity Type | Individual
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Provider Name | PATRICIA ANN GROMOSHAK MSRPT
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Gender | Female
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 200 GARDEN ST
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City | FARMINGTON
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State | CT
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Zip | 06032-2257
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Country | US
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Telephone | 860-677-7193
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Fax | 860-674-9247
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Provider Business Mailing Address
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Address Line | 3396 EAST MAIN STREET
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 860-677-7193
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Fax | 860-674-9247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 002142
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License Number State | CT
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