Provider Demographics
NPI:1053557231
Name:DORSON, EMILY S (LATC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:DORSON
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SOUTH ST UNIT 60
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4418
Mailing Address - Country:US
Mailing Address - Phone:603-557-4163
Mailing Address - Fax:214-416-0186
Practice Address - Street 1:165 SOUTH ST UNIT 60
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4418
Practice Address - Country:US
Practice Address - Phone:603-557-4163
Practice Address - Fax:214-416-0186
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1102021882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer