Provider Demographics
NPI:1386183887
Name:VIOLETTE, JANUARY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JANUARY
Middle Name:
Last Name:VIOLETTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JANUARY
Other - Middle Name:M
Other - Last Name:KUBICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:136 WEST MAIN STREET
Mailing Address - Street 2:CONNECTICUT ORTHOPEDIC REHABILITATION ASSOCIATES
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1315
Mailing Address - Country:US
Mailing Address - Phone:860-826-4763
Mailing Address - Fax:860-826-4762
Practice Address - Street 1:136 WEST MAIN STREET
Practice Address - Street 2:CORA
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-225-7429
Practice Address - Fax:860-826-4762
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1553225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant