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Individual

MIHAELA M MACK

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
RPT

Contact information

Practice address
45 GROVE ST, NEW CANAAN, CT 06840-5330
(203) 966-5752
(203) 966-7507
Mailing address
51 CONRAD RD, NEW CANAAN, CT 06840-6725
(203) 966-1015

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
CT05123
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080005123CT01
ANTHEM BC/BS
CT
01
ANC1555
OXFORD
CT
Enumeration date
08/17/2005
Last updated
07/08/2007
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