Provider Demographics
NPI:1215990551
Name:ELMO, BRIAN (MPT, ATC, CS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:ELMO
Suffix:
Gender:M
Credentials:MPT, ATC, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 EAST AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5725
Mailing Address - Country:US
Mailing Address - Phone:203-957-8162
Mailing Address - Fax:203-957-8165
Practice Address - Street 1:166 EAST AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5725
Practice Address - Country:US
Practice Address - Phone:203-957-8162
Practice Address - Fax:203-957-8165
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9077328OtherPHCS
CT7488045OtherAETNA
CT9077328OtherPHCS