Provider Demographics
NPI:1124218862
Name:BISHNOI, ANAND K (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANAND
Middle Name:K
Last Name:BISHNOI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CROMWELL AVE
Mailing Address - Street 2:STE Q
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3013
Mailing Address - Country:US
Mailing Address - Phone:860-257-3779
Mailing Address - Fax:860-257-3780
Practice Address - Street 1:825 CROMWELL AVE
Practice Address - Street 2:STE Q
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3013
Practice Address - Country:US
Practice Address - Phone:860-257-3779
Practice Address - Fax:860-257-3780
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080004389CT24OtherBCBS, BCFP, MEDIBLUE BCBS
CT004167161Medicaid
CT060916784004OtherTRICARE
CT004167161Medicaid