Healthcare Provider Details

I. General information

NPI: 1588214381
Provider Name (Legal Business Name): GOOD PHYSIO CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COTTAGE GROVE RD STE 110
BLOOMFIELD CT
06002-3080
US

IV. Provider business mailing address

701 COTTAGE GROVE RD STE 110
BLOOMFIELD CT
06002-3080
US

V. Phone/Fax

Practice location:
  • Phone: 860-318-5682
  • Fax: 860-318-5682
Mailing address:
  • Phone: 860-318-5682
  • Fax: 860-318-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CHANG YOON
Title or Position: DIRECTOR
Credential: PT
Phone: 860-937-2934