Provider Demographics
NPI:1477939403
Name:SOBOLEWSKI, AMY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SOBOLEWSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARIDON RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1526
Mailing Address - Country:US
Mailing Address - Phone:860-841-0540
Mailing Address - Fax:
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1933
Practice Address - Country:US
Practice Address - Phone:860-561-3960
Practice Address - Fax:860-561-4803
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist