Provider Demographics
NPI:1568820033
Name:CONNECTICUT BRACE AND LIMB
Entity Type:Organization
Organization Name:CONNECTICUT BRACE AND LIMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:860-740-2154
Mailing Address - Street 1:131 MAIN STREET EXT # 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3812
Mailing Address - Country:US
Mailing Address - Phone:860-740-2154
Mailing Address - Fax:860-421-4178
Practice Address - Street 1:131 MAIN STREET EXT FL 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3812
Practice Address - Country:US
Practice Address - Phone:860-740-2154
Practice Address - Fax:860-421-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation