Individual
MS. PATTYA JEAN GANJANATHAVAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
163 BROAD ST, MILFORD, CT 06460-4726
(203) 513-9594
Mailing address
303R ISINGLASS RD, SHELTON, CT 06484-5708
(405) 613-0731
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9711
CT
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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