Healthcare Provider Details

I. General information

NPI: 1982980546
Provider Name (Legal Business Name): ALL STAR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

21 WATERVILLE RD
AVON CT
06001-2097
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-2934
  • Fax:
Mailing address:
  • Phone: 860-677-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000128
License Number StateCT

VIII. Authorized Official

Name: MRS. MAGDALEN DANIEL
Title or Position: PHYSICAL THERAPY ASSISTANT
Credential: PTA
Phone: 860-677-2934