Individual
MARCUS BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1138 FARMINGTON AVE, BERLIN, CT 06037
(860) 829-5511
(860) 829-5577
Mailing address
1138 FARMINGTON AVE, P.O. BOX 452, BERLIN, CT 06037
(860) 829-5511
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007144
LICENSE#
CT
Enumeration date
08/25/2006
Last updated
01/23/2020
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