Provider Demographics
NPI:1225070519
Name:SLEVINSKY, ROMAN TARAS (PT)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:TARAS
Last Name:SLEVINSKY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-0686
Mailing Address - Country:US
Mailing Address - Phone:860-928-3533
Mailing Address - Fax:860-928-3533
Practice Address - Street 1:25 QUINEBAUG AVE
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1943
Practice Address - Country:US
Practice Address - Phone:860-928-3533
Practice Address - Fax:860-928-3533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist