Basic Information
| Provider Information | |||||||||
| NPI: | 1619964475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRETSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSPT ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 GEORGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034985980 | ||||||||
| FaxNumber: | 2034985999 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 S MAIN ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064103148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032723120 | ||||||||
| FaxNumber: | 2032723151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 007158 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.