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General NPI Number Information
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NPI Number | 1588554802
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Entity Type | Individual
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Provider Name | JASON BRACICH PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 3 FARM RD
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City | NEW CANAAN
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State | CT
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Zip | 06840-6626
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Country | US
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Telephone | 203-594-5340
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Fax |
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Provider Business Mailing Address
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Address Line | 196 FOREST RD
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City | STORRS MANSFIELD
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State | CT
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Zip | 06268-1117
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Country | US
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Telephone | 970-759-8580
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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 | 013453
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License Number State | CT
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