Healthcare Provider Details

I. General information

NPI: 1558503953
Provider Name (Legal Business Name): TEMPLE PT & LIFE SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 N MAIN ST
BRANFORD CT
06405-3061
US

IV. Provider business mailing address

230 GEORGE ST
NEW HAVEN CT
06510-3224
US

V. Phone/Fax

Practice location:
  • Phone: 203-483-2509
  • Fax: 203-483-2513
Mailing address:
  • Phone: 203-498-5980
  • Fax: 203-498-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LORI MONTALTO
Title or Position: DIRECTOR
Credential:
Phone: 203-407-3508