Provider Demographics
NPI:1568571131
Name:TRAHANT, TIMOTHY R (LAC, PT, MSTCM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:TRAHANT
Suffix:
Gender:M
Credentials:LAC, PT, MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TWIN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1870
Mailing Address - Country:US
Mailing Address - Phone:860-669-9066
Mailing Address - Fax:
Practice Address - Street 1:25 WATER ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2868
Practice Address - Country:US
Practice Address - Phone:860-552-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT262171100000X
CT7329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007329OtherLICENSE #