Healthcare Provider Details

I. General information

NPI: 1396871661
Provider Name (Legal Business Name): HIGGANUM PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3A CANDLEWOOD HILL ROAD
HIGGANUM CT
06441-4202
US

IV. Provider business mailing address

PO BOX 619
HIGGANUM CT
06441-0619
US

V. Phone/Fax

Practice location:
  • Phone: 860-345-2622
  • Fax: 860-345-2626
Mailing address:
  • Phone: 860-345-2622
  • Fax: 860-345-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004600
License Number StateCT

VIII. Authorized Official

Name: MICHELE R. GRASSO
Title or Position: OWNER/THERAPIST
Credential: RPT
Phone: 860-345-2622