Healthcare Provider Details

I. General information

NPI: 1407062227
Provider Name (Legal Business Name): NEW CANAAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GROVE ST
NEW CANAAN CT
06840-5330
US

IV. Provider business mailing address

45 GROVE ST
NEW CANAAN CT
06840-5330
US

V. Phone/Fax

Practice location:
  • Phone: 203-966-5752
  • Fax: 203-966-7507
Mailing address:
  • Phone: 203-966-5752
  • Fax: 203-966-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007011
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002635
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005123
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007229
License Number StateCT

VIII. Authorized Official

Name: MRS. ELAINE HRISTON ZECH
Title or Position: OWNER-DIRECTOR-PHYSICAL THERAPIST
Credential:
Phone: 203-966-5752