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General NPI Number Information
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NPI Number | 1922776434
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Entity Type | Individual
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Provider Name | THOMAS MAGDA DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 11 MILL POND DR
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City | GRANBY
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State | CT
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Zip | 06035-2628
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Country | US
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Telephone | 860-413-9969
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Fax |
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Provider Business Mailing Address
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Address Line | 36 OLD PEPPERIDGE LN APT C1
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City | WETHERSFIELD
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State | CT
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Zip | 06109-3131
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Country | US
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Telephone | 203-641-0089
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1094
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License Number State | CT
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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 | 13279
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License Number State | CT
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