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General NPI Number Information
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NPI Number | 1720693070
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Entity Type | Individual
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Provider Name | ALEXANDER RICHARD MARTIN
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Gender | Male
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 2154 E MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06705-2608
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Country | US
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Telephone | 203-575-0516
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Fax | 203-575-0682
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Provider Business Mailing Address
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Address Line | 22 TOMPKINS STREET
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City | WATERBURY
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State | CT
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Zip | 06708-1458
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Country | US
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Telephone | 203-598-0600
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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 | 12792
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License Number State | CT
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