# DANBURY PHYSICAL MEDICINE AND REHABILITATION PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306087838
- **Authorized official:** MS. NIKKI C BLAYZOR (MANAGER)
- **Authorized official phone:** (203) 207-9840

## Contact information

- **Practice address:** 109 NEWTON RD, SUITE 1, DANBURY, CT 06810-4120
- **Practice address phone:** (203) 207-9840
- **Practice address fax:** (203) 207-9849
- **Mailing address:** 109 NEWTON RD, SUITE 1, DANBURY, CT 06810-4120
- **Mailing address phone:** (203) 207-9840
- **Mailing address fax:** (203) 207-9849

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 043130 | CT | Yes |

## Other

- **Enumeration date:** 03/12/2009
- **Last updated:** 12/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | D100007621 | MEDICARE PTAN | CT |