Provider Demographics
NPI:1699793463
Name:BRONNER, ELIZABETH L (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:L
Last Name:BRONNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:L
Other - Last Name:GALANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:97 SALMON BROOK ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2607
Mailing Address - Country:US
Mailing Address - Phone:860-844-8912
Mailing Address - Fax:860-844-8912
Practice Address - Street 1:97 SALMON BROOK ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2607
Practice Address - Country:US
Practice Address - Phone:860-844-8912
Practice Address - Fax:860-844-8912
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19529225100000X
CT7603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076572OtherMEDICARE GROUP ID
CTXV2528OtherHEALTHNET PROVIDER ID
CT7687681OtherAETNA PROVIDER ID
CT0010901OtherORTHONET/HEALTHNET PROV