Provider Demographics
NPI:1285642900
Name:NIETCH, LAURA M (PT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:M
Last Name:NIETCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:245 ALVORD PARK ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3493
Mailing Address - Country:US
Mailing Address - Phone:860-496-9851
Mailing Address - Fax:860-482-4047
Practice Address - Street 1:245 ALVORD PARK ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3493
Practice Address - Country:US
Practice Address - Phone:860-496-9851
Practice Address - Fax:860-482-4047
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004224549Medicaid
CT080006617CT05OtherANTHEM BCBS
CT004224549Medicaid