Basic Information
| Provider Information | |||||||||
| NPI: | 1497035927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOKLOSA | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | KATHERINE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 REYNOLDS FARM RD | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067763863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603555401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 POMPERAUG OFFICE PARK | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032641735 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2011 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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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 | 225200000X | 001004 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.