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Individual

IAN BROKAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
65 ALBANY TPKE, CANTON, CT 06019-2507
(860) 693-6226
(860) 693-8002
Mailing address
PO BOX 466, CANTON, CT 06019-0466
(860) 693-6226
(860) 693-8002

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
10642
CT
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
10642
CT

Other

Enumeration date
04/16/2018
Last updated
04/16/2018
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