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DIANE K LONG PT
>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1174595953
Individual Registrant: DIANE K LONG PT
Gender: F
Gender: F
Location and contact information for practice:
6 GREENWICH OFFICE PARK GREENWICH, CT 06831-5151 US
Tel: 203-869-1145 Fax: 203-629-7606
Tel: 203-869-1145 Fax: 203-629-7606
Contact information for business:
6 GREENWICH OFFICE PARK GREENWICH, CT 06831-5151 US
Tel: 203-869-1145 Fax: 203-629-7606
Tel: 203-869-1145 Fax: 203-629-7606
Registration Information:
NPI: 1174595953
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist | CT | 003812 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AETNA | 3120763 | CT | 01 |
| ANTHEM BCBS | 080003812CT04 | CT | 01 |
