Douglass, Robert Edward

Douglass, Robert Edward is an individual health care provider with primary practice located at 22 Tompkins St , Waterbury CT 06708-1458. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Douglass, Robert Edward can be contacted via phone (203) 419-0381.

Contact Information

Primary practice address
22 Tompkins St Waterbury CT 06708-1458
Phone: (203) 419-0381
Fax: (203) 419-0389
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 006694 Connecticut
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 000174 Connecticut

Profile Details

NPI number 1134281587
LBN Legal business name Douglass, Robert Edward
Credentials PT, ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2006
Last updated Mar 8th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134281587 NPPES
Connecticut Other 006694 PHYSICAL THERAPY LICENSE
Connecticut MEDICAID 004190328 PHYSICAL THERAPY LICENSE
Connecticut Other 000174 PHYSICAL THERAPY LICENSE

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