Individual
BRIAN V ELSEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2 POMPERAUG OFFICE PARK, SUITE 303, SOUTHBURY, CT 06488-2288
(203) 264-1735
(203) 264-9251
Mailing address
57 JUNIPER RIDGE DR, WATERBURY, CT 06708-1933
(203) 755-4563
(203) 264-9251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007571
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080007571CT01
BLUE SHIELD
CT
Enumeration date
04/25/2006
Last updated
10/29/2007
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