Provider Demographics
NPI:1053374348
Name:HAHN, CAROL (PT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E WAKEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-2976
Mailing Address - Country:US
Mailing Address - Phone:860-559-0747
Mailing Address - Fax:860-238-7787
Practice Address - Street 1:115 SPENCER ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098
Practice Address - Country:US
Practice Address - Phone:860-559-0747
Practice Address - Fax:860-738-9395
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052086132251G0304X, 2251X0800X
MA110502251X0800X
CT0057142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67757OtherBCBS PROVIDER ID
CT080005714OtherBCBS PROVIDER ID
CT650001210Medicare ID - Type UnspecifiedPT PROVIDER ID