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General NPI Number Information
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NPI Number | 1659685006
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Entity Type | Individual
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Provider Name | JENNIE REESE PTA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 376 GOSHEN RD
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City | TORRINGTON
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State | CT
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Zip | 06790-2722
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Country | US
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Telephone | 860-618-0416
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Fax |
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Provider Business Mailing Address
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Address Line | 376 GOSHEN RD
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City | TORRINGTON
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State | CT
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Zip | 06790-2722
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 001094
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License Number State | CT
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