Healthcare Provider Details

I. General information

NPI: 1245385426
Provider Name (Legal Business Name): COMMUNITY THERAPEUTIX PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROAD ST # B
NEW LONDON CT
06320-2544
US

IV. Provider business mailing address

601 BROAD ST # B
NEW LONDON CT
06320-2544
US

V. Phone/Fax

Practice location:
  • Phone: 860-848-4180
  • Fax: 860-574-9393
Mailing address:
  • Phone: 860-848-4180
  • Fax: 860-574-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number001800
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001446
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY F STELIK OTR/L
Title or Position: DIRECTOR/OWNER
Credential: OTR/L
Phone: 860-848-9157