Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 225400000X | Rehabilitation Practitioner | | | | No |
| 2 | 261QR0401X | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | | CONNECTICUT | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 40101 | OTHER | CONNECTICUT | CIGNA ORTHONET STRATFORD |
| 2 | 40102 | OTHER | CONNECTICUT | CIGNA ORTHONET MILFORD |
| 3 | 004060836 | MEDICAID | CONNECTICUT | |
| 4 | 40104 | OTHER | CONNECTICUT | CIGNA ORTHONET FAIRFIELD |
| 5 | 196387 | OTHER | CONNECTICUT | UNITED HEALTHCARE |
| 6 | 609649 | OTHER | CONNECTICUT | CONNECTICARE |
| 7 | 70618 | OTHER | CONNECTICUT | AETNA |
| 8 | 001570 | OTHER | CONNECTICUT | HEALTHNET |
| 9 | 800009109CT01 | OTHER | CONNECTICUT | BCBS PT/SP |
| 10 | =========001 | OTHER | CONNECTICUT | TRICARE FAIRFIELD |
| 11 | 40103 | OTHER | CONNECTICUT | CIGNA ORTHONET SHELTON |
| 12 | C02780 | OTHER | CONNECTICUT | FIRST COAST |
| 13 | 40105 | OTHER | CONNECTICUT | CIGNA ORTHONET WESTPORT |
| 14 | ANC1205 | OTHER | CONNECTICUT | OXFORD |
| 15 | 0089222 | OTHER | CONNECTICUT | CIGNA |
| 16 | 076516 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
| 17 | 70618 | OTHER | CONNECTICUT | US HEALTHCARE |
| 18 | 800009109CT02 | OTHER | CONNECTICUT | BCBS OT |
| 19 | 074505 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
