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General NPI Number Information
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NPI Number | 1699514976
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Entity Type | Individual
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Provider Name | JACOB ZACHARY CARLSON DPT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 972 W MAIN ST
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City | NEW BRITAIN
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State | CT
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Zip | 06053-3487
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Country | US
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Telephone | 860-827-0745
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Fax |
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Provider Business Mailing Address
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Address Line | 60 KEENEY DR
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City | BOLTON
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State | CT
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Zip | 06043-7328
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Country | US
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Telephone | 860-461-3034
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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 | 14445
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License Number State | CT
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