Basic Information
Provider Information
NPI: 1336484245
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROZEA
FirstName: STEVEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 47 N MAIN ST
Address2:  
City: WEST HARTFORD
State: CT
PostalCode: 061071926
CountryCode: US
TelephoneNumber: 8604094595
FaxNumber: 8604094860
Practice Location
Address1: 385 CHURCH ST
Address2:  
City: GUILFORD
State: CT
PostalCode: 064376003
CountryCode: US
TelephoneNumber: 2034532844
FaxNumber: 2034538772
Other Information
ProviderEnumerationDate: 12/04/2012
LastUpdateDate: 08/21/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X9622CTY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X1214529TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X11656CON Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X27304FLN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X20290MAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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