Provider Demographics
NPI:1841496981
Name:TRAEGER-SPEES, ANN (PT)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:TRAEGER-SPEES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-0423
Mailing Address - Country:US
Mailing Address - Phone:860-961-0904
Mailing Address - Fax:
Practice Address - Street 1:3175 GOLD STAR HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1200
Practice Address - Country:US
Practice Address - Phone:860-961-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist