Provider Demographics
NPI:1013227081
Name:TRUMBULL, EMMA ALEXANDRA (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:ALEXANDRA
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1642
Mailing Address - Country:US
Mailing Address - Phone:203-258-8560
Mailing Address - Fax:
Practice Address - Street 1:25 CEDAR RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1642
Practice Address - Country:US
Practice Address - Phone:203-258-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25555225100000X
CT5380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist