Provider Demographics
NPI:1366129199
Name:FINN, ETHAN L (DPT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:L
Last Name:FINN
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 1:86 BOSTON POST RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2434
Mailing Address - Country:US
Mailing Address - Phone:860-691-8960
Mailing Address - Fax:860-444-1671
Practice Address - Street 1:86 BOSTON POST RD STE 1
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2434
Practice Address - Country:US
Practice Address - Phone:860-691-8960
Practice Address - Fax:860-444-1671
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT14168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist