Individual
MR. MITCHELL BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
26 SHENIPSIT LAKE RD, TOLLAND, CT 06084-2332
(860) 872-2999
Mailing address
439 BIGELOW HOLLOW RD, EASTFORD, CT 06242-9302
(860) 836-7480
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5372
CT
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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