Healthcare Provider Details

I. General information

NPI: 1285431130
Provider Name (Legal Business Name): PREFERRED THERAPY OUTPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 DROZDYK DR
GROTON CT
06340-4248
US

IV. Provider business mailing address

850 SILAS DEANE HWY FL 2
WETHERSFIELD CT
06109-3440
US

V. Phone/Fax

Practice location:
  • Phone: 860-610-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL MAIOCCO PERCOCO
Title or Position: DIRECTOR OF OUTPATIENT SERVICES
Credential:
Phone: 860-918-4742