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General NPI Number Information
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NPI Number | 1760172001
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Entity Type | Organization
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Legal Business Name | JOINT PAIN TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 417 HIGHLAND AVE
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City | WATERBURY
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State | CT
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Zip | 06708-3454
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Country | US
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Telephone | 203-504-7518
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Fax |
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Provider Business Mailing Address
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Address Line | 417 HIGHLAND AVE
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City | WATERBURY
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State | CT
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Zip | 06708-3454
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Country | US
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Telephone | 203-504-7518
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Fax |
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Authorized Official
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Title or Position | OWNER, NP DIRECTOR
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Name | KRISTEN DONOHUE
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Credential | NP
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Telephone | 203-895-6572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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