Healthcare Provider Details

I. General information

NPI: 1609782630
Provider Name (Legal Business Name): CT LYMPH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SHAWN DR
BRISTOL CT
06010-2737
US

IV. Provider business mailing address

163 ROCK CREEK LN
TORRINGTON CT
06790-3564
US

V. Phone/Fax

Practice location:
  • Phone: 959-988-2981
  • Fax:
Mailing address:
  • Phone: 959-988-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MUHAMMAD DANISH IQBAL
Title or Position: OWNER
Credential: PT
Phone: 959-988-2981