Individual
MRS. GEORGIANNA FORMAN TATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
60 WESTWOOD AVE, WATERBURY, CT 06708-2460
(203) 597-1609
(203) 597-1581
Mailing address
219 MATTHEW ST, PROSPECT, CT 06712-1417
(203) 758-4249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006595
CT
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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