Healthcare Provider Details

I. General information

NPI: 1235408840
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAIN ST UNIT 2-A
MONROE CT
06468-1116
US

IV. Provider business mailing address

PO BOX 1245
INDIANA PA
15701-5245
US

V. Phone/Fax

Practice location:
  • Phone: 203-816-6505
  • Fax: 203-816-9833
Mailing address:
  • Phone: 724-465-3496
  • Fax: 215-413-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAYNE FLECK POOL
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 469-467-8705