Healthcare Provider Details

I. General information

NPI: 1609004340
Provider Name (Legal Business Name): YOGABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 REEF RD SUITE 209
FAIRFIELD CT
06824-6537
US

IV. Provider business mailing address

325 REEF RD SUITE 209
FAIRFIELD CT
06824-6537
US

V. Phone/Fax

Practice location:
  • Phone: 203-292-6365
  • Fax: 203-292-6366
Mailing address:
  • Phone: 203-292-6365
  • Fax: 203-292-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003703
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00579
License Number StateCT

VIII. Authorized Official

Name: THEODORA ANN BARENHOLTZT
Title or Position: OWNER
Credential: RPT
Phone: 203-292-6365