Healthcare Provider Details

I. General information

NPI: 1790084390
Provider Name (Legal Business Name): CARLSON THERAPY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NEWTOWN RD # A SUITE 5
DANBURY CT
06810-4194
US

IV. Provider business mailing address

105 NEWTOWN RD # A SUITE 5
DANBURY CT
06810-4194
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-0765
  • Fax: 203-739-0792
Mailing address:
  • Phone: 203-739-0765
  • Fax: 203-739-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number006116
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number000144
License Number StateCT

VIII. Authorized Official

Name: RICHARD E CARLSON
Title or Position: CEO
Credential: PT
Phone: 203-739-0765