Provider Demographics
NPI:1497996698
Name:MURAMATSU-MOFFAT, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MURAMATSU-MOFFAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 WHITNEY AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3691
Mailing Address - Country:US
Mailing Address - Phone:203-288-5913
Mailing Address - Fax:203-281-3117
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-288-5913
Practice Address - Fax:203-281-3117
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0071262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic