Individual
DR. JOHN DETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, RYT-200
Contact information
Practice address
HSS SPORTS REHAB, 564 SOUTH AVENUE, NEW CANAAN, CT 06840
(203) 276-8597
Mailing address
334 WESTOVER RD, STAMFORD, CT 06902-1929
(202) 213-6047
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
012450
CT
Other
Enumeration date
08/05/2022
Last updated
08/05/2022
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