Individual
MISS LAURA M NIETCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006617
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004224549
—
CT
01
—
080006617CT05
ANTHEM BCBS
CT
Enumeration date
08/04/2006
Last updated
06/13/2013
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