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General NPI Number Information
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NPI Number | 1922333699
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Entity Type | Individual
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Provider Name | YELENA WASSER
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Gender | Female
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 45 MERIDEN AVE
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3214
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Country | US
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Telephone | 860-621-9559
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Fax |
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Provider Business Mailing Address
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Address Line | 43 SHEEP HILL DR
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City | WEST HARTFORD
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State | CT
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Zip | 06117-1635
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 19111
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008644
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License Number State | CT
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