Individual
BRIAN WIRTALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, CSCS
Contact information
Practice address
29 HAYNES ST, SUITE A, MANCHESTER, CT 06040-4139
(860) 649-2267
(860) 654-9753
Mailing address
181 PATRICIA M GENOVA DR, NEWINGTON, CT 06111-1500
(860) 696-2550
(860) 696-2525
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9872
CT
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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