Provider Demographics
NPI:1720163009
Name:PAUL, JOEL (MSPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE #801
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2296
Mailing Address - Country:US
Mailing Address - Phone:203-389-4593
Mailing Address - Fax:203-389-4609
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE #801
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2296
Practice Address - Country:US
Practice Address - Phone:203-389-4593
Practice Address - Fax:203-389-4609
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007421CT07OtherANTHEM BC BS
CT080007421CT05OtherANTHEM BC BS
CT080007421CT06OtherANTHEM BC BS
CT080007421CT05OtherANTHEM BC BS