Provider Demographics
NPI:1770183030
Name:FEDYNA DEMBECK, ADRIENNE LARA (MED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LARA
Last Name:FEDYNA DEMBECK
Suffix:
Gender:F
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NEW BRITAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3167
Mailing Address - Country:US
Mailing Address - Phone:860-827-1333
Mailing Address - Fax:860-223-9238
Practice Address - Street 1:211 NEW BRITAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3167
Practice Address - Country:US
Practice Address - Phone:860-827-1333
Practice Address - Fax:860-223-9238
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer