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General NPI Number Information
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NPI Number | 1962241026
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Entity Type | Individual
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Provider Name | RACHEL GORNEAULT PTA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 650 WOLCOTT RD
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City | WOLCOTT
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State | CT
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Zip | 06716-2427
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Country | US
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Telephone | 203-879-6700
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Fax | 203-879-6725
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Provider Business Mailing Address
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Address Line | 22 TOMPKINS ST
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City | WATERBURY
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State | CT
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Zip | 06708
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Country | US
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Telephone | 203-598-0600
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Fax | 203-598-3300
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 64
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License Number State | CT
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