Provider Demographics
NPI:1265955132
Name:LITWIN, LAURA ANN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:LITWIN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06459-3213
Mailing Address - Country:US
Mailing Address - Phone:860-685-3980
Mailing Address - Fax:
Practice Address - Street 1:161 CROSS ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06459-3213
Practice Address - Country:US
Practice Address - Phone:860-685-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008602255A2300X, 2083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine