Provider Demographics
NPI:1972674836
Name:HEWITT, ROBERT JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:HEWITT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512
Mailing Address - Country:US
Mailing Address - Phone:203-469-5731
Mailing Address - Fax:203-467-3894
Practice Address - Street 1:32 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512
Practice Address - Country:US
Practice Address - Phone:203-469-5731
Practice Address - Fax:203-467-3894
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000952OtherAETNA
00409515600OtherBC FAMILY
080003487CT03OtherBC
0112701OtherORTHONET HNET
706624OtherCT CARE
A773123OtherOXFORD
42800908OtherPHCS
OV6237OtherHEALTHNET
CT65000230Medicare PIN