Provider Demographics
NPI:1821060666
Name:FORBERG, LIV (MS,PT)
Entity Type:Individual
Prefix:
First Name:LIV
Middle Name:
Last Name:FORBERG
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GROVE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4112
Mailing Address - Country:US
Mailing Address - Phone:203-438-1898
Mailing Address - Fax:203-438-1864
Practice Address - Street 1:66 GROVE ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4112
Practice Address - Country:US
Practice Address - Phone:203-438-1898
Practice Address - Fax:203-438-1864
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ00H4OtherEMPIRE BLUE CROSS