Basic Information
| Provider Information | |||||||||
| NPI: | 1063466480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZUJEWSKI | ||||||||
| FirstName: | RENATA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 N MAIN ST | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064892503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606217389 | ||||||||
| FaxNumber: | 8606212586 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 N MAIN ST | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064892503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606217389 | ||||||||
| FaxNumber: | 8606212586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 006525 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004252178 | 05 | CT | MEDICAID |