Individual
ROBERT EDWARD DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
22 TOMPKINS ST, WATERBURY, CT 06708-1458
(203) 419-0381
(203) 419-0389
Mailing address
22 TOMPKINS ST, WATERBURY, CT 06708-1458
(203) 419-0381
(203) 419-0389
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006694
CT
2255A2300X
Athletic Trainer
000174
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000174
ATC LICENSE
CT
05
—
004190328
—
CT
01
—
006694
PHYSICAL THERAPY LICENSE
CT
Enumeration date
12/14/2006
Last updated
03/08/2013
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