Healthcare Provider Details

I. General information

NPI: 1376760892
Provider Name (Legal Business Name): ELLINGTON PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WEST RD SUITE 6A
ELLINGTON CT
06029-3730
US

IV. Provider business mailing address

175 WEST ROAD SUITE 6A
ELLINGTON CT
06029
US

V. Phone/Fax

Practice location:
  • Phone: 860-896-9275
  • Fax: 860-896-9265
Mailing address:
  • Phone: 860-896-9275
  • Fax: 860-896-9265

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: MR. JONATHAN ECKERT
Title or Position: OWNER MANAGER
Credential: MSPT
Phone: 860-265-2392