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General NPI Number Information
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NPI Number | 1144114216
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Entity Type | Individual
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Provider Name | MARY KALLBERG
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Gender | Female
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 98 MILL PLAIN RD STE 3B
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City | DANBURY
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State | CT
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Zip | 06811-6101
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Country | US
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Telephone | 203-616-2312
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Fax | 203-616-2313
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Provider Business Mailing Address
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Address Line | 47 N MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1926
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Country | US
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Telephone | 860-409-4595
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14945
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License Number State | CT
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