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General NPI Number Information
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NPI Number | 1962564971
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Entity Type | Individual
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Provider Name | GLEN THOMAS GITTERMAN MS, PT, RKT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2440 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3222
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Country | US
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Telephone | 203-230-1185
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Fax | 203-230-0776
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Provider Business Mailing Address
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Address Line | 169 DEXTER AVE
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City | MERIDEN
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State | CT
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Zip | 06450-6112
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Country | US
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Telephone | 203-237-9672
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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 | 004343
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License Number State | CT
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