Individual
MARK GOMBOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 DAVIS RD E, OLD LYME, CT 06371-1447
(860) 434-9155
Mailing address
35 MALLARD LN, KENSINGTON, CT 06037-3553
(860) 828-6873
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005690
LICENSE #
CT
Enumeration date
08/28/2006
Last updated
07/08/2007
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