Provider Demographics
NPI:1023074309
Name:ELSEMORE, BRIAN V (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:V
Last Name:ELSEMORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 JUNIPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1933
Mailing Address - Country:US
Mailing Address - Phone:203-755-4563
Mailing Address - Fax:203-264-9251
Practice Address - Street 1:2 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 303
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2288
Practice Address - Country:US
Practice Address - Phone:203-264-1735
Practice Address - Fax:203-264-9251
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007571CT01OtherBLUE SHIELD