Basic Information
| Provider Information | |||||||||
| NPI: | 1821645300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINNEMA | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TERESHCHUK | ||||||||
| OtherFirstName: | OLGA | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 435 HARTFORD TPKE STE U | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609791611 | ||||||||
| FaxNumber: | 8602630986 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 MOUNTAIN ROAD | ||||||||
| Address2: | |||||||||
| City: | SUFFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606689589 | ||||||||
| FaxNumber: | 8606689802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2019 | ||||||||
| LastUpdateDate: | 10/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 012328 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.