Provider Demographics
NPI:1063991164
Name:WADSWORTH, GARRETT WAYNE (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:WAYNE
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6 GREENWICH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5151
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-618-1721
Practice Address - Street 1:211 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-398-4030
Practice Address - Fax:860-894-1894
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305212243225100000X
VT040.0134031225100000X
CT12454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist