| Doctor Name: | MRS. GEORGIANNA FORMAN TATA |
| NPI Number: | 1790796688 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 006595 |
| Business Practice Address: | 60 Westwood Ave Waterbury, CT - 067082460 |
| Business Phone Number: | 2035971609 |
| Business Fax Number: | 2035971581 |
| Mailing Address: | 219 Matthew St, PROSPECT |
| State: | CT |
| Postal Code: | 067121417 |
| Phone Number: | 2037584249 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 006595 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |