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General NPI Number Information
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NPI Number | 1346824836
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Entity Type | Individual
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Provider Name | MIKHAIL KLAKOTSKIY DPT
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Gender | Male
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 25 LORRAINE ST
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City | HARTFORD
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State | CT
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Zip | 06105-2242
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Country | US
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Telephone | 860-233-8241
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Fax |
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Provider Business Mailing Address
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Address Line | 420 MAIN ST APT 62
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City | AGAWAM
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State | MA
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Zip | 01001-1844
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Country | US
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Telephone | 413-426-2555
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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 | 012324
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25470
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License Number State | MA
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