Individual
MR. DOMINICK EDWARD DESLAURIERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
693 BLOOMFIELD AVE, 2ND FLOOR, BLOOMFIELD, CT 06002-2489
(860) 242-8427
(860) 242-4147
Mailing address
693 BLOOMFIELD AVE, 2ND FLOOR, BLOOMFIELD, CT 06002-2489
(860) 242-8427
(860) 242-4147
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
CT4979
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080004979CT04
ANTHEM BC/BS
CT
Enumeration date
04/14/2006
Last updated
12/20/2007
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