Provider Demographics
NPI:1265210991
Name:ALDRICH, DAKOTA SEAN (DPT)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:SEAN
Last Name:ALDRICH
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 1:435 HARTFORD TPKE STE U
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4834
Mailing Address - Country:US
Mailing Address - Phone:860-870-8272
Mailing Address - Fax:860-875-0804
Practice Address - Street 1:9B FIELDSTONE CMNS
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3421
Practice Address - Country:US
Practice Address - Phone:860-870-9800
Practice Address - Fax:860-870-9806
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist