Provider Demographics
NPI:1346207073
Name:JOSEPH, BETTY (PT)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:93 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095
Mailing Address - Country:US
Mailing Address - Phone:860-242-7973
Mailing Address - Fax:
Practice Address - Street 1:705 BLOOMFIELD AVE
Practice Address - Street 2:STE 101
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-242-8427
Practice Address - Fax:860-242-4147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT3540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080003540CT06OtherANTHEM BC/BS