Provider Demographics
NPI:1851804710
Name:CHIN, ANDREW DENNIS (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DENNIS
Last Name:CHIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 B GROVE STREET
Mailing Address - Street 2:CARLSON THERAPY NETWORK
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776
Mailing Address - Country:US
Mailing Address - Phone:860-799-6320
Mailing Address - Fax:860-799-6621
Practice Address - Street 1:10 B ELIZABETH STREET
Practice Address - Street 2:CARLSON THERAPY NETWORK
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2100
Practice Address - Country:US
Practice Address - Phone:203-778-0720
Practice Address - Fax:203-778-6187
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist