Provider Demographics
NPI:1598717670
Name:PIROG, KATHERINE B (ATC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:B
Last Name:PIROG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1967
Mailing Address - Country:US
Mailing Address - Phone:860-229-8682
Mailing Address - Fax:
Practice Address - Street 1:1615 STANLEY ST
Practice Address - Street 2:KAISER HALL
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06050-2439
Practice Address - Country:US
Practice Address - Phone:860-832-3062
Practice Address - Fax:860-832-3169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer