Individual
DIANE K LONG
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6 GREENWICH OFFICE PARK, GREENWICH, CT 06831-5151
(203) 869-1145
(203) 629-7606
Mailing address
6 GREENWICH OFFICE PARK, GREENWICH, CT 06831-5151
(203) 869-1145
(203) 629-7606
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003812
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080003812CT04
ANTHEM BCBS
CT
01
—
3120763
AETNA
CT
Enumeration date
02/06/2006
Last updated
07/08/2007
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