Healthcare Provider Details

I. General information

NPI: 1205086584
Provider Name (Legal Business Name): EASTERN REHABILITATION NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 ELM STREET EASTERN REHABILITATION NETWORK
ENFIELD CT
06082
US

IV. Provider business mailing address

181 PATRICIA M. GENOVA DRIVE EASTERN REHABILITATION NETWORK
NEWINGTON CT
06111
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-5480
  • Fax:
Mailing address:
  • Phone: 860-667-5480
  • Fax: 860-667-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCT

VIII. Authorized Official

Name: RITA PARISI
Title or Position: CEO
Credential:
Phone: 860-667-5480