Healthcare Provider Details

I. General information

NPI: 1215912373
Provider Name (Legal Business Name): MANSFIELD PHYSICAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 STAFFORD RD
MANSFIELD CTR CT
06250-1441
US

IV. Provider business mailing address

175 STAFFORD RD
MANSFIELD CTR CT
06250-1441
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-8869
  • Fax: 860-450-1936
Mailing address:
  • Phone: 860-456-8869
  • Fax: 860-450-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001450
License Number StateCT

VIII. Authorized Official

Name: MARCIA A DONOFRIO
Title or Position: SUPERVISOR OWNER
Credential: RPT
Phone: 860-456-8869