Healthcare Provider Details

I. General information

NPI: 1174749329
Provider Name (Legal Business Name): HARTFORD HEALTHCARE REHABILITATION NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 PATRICIA M GENOVA DR SUITE A200
NEWINGTON CT
06111-1500
US

IV. Provider business mailing address

181 PATRICIA M GENOVA DR SUITE A200
NEWINGTON CT
06111-1500
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-2550
  • Fax: 860-696-2525
Mailing address:
  • Phone: 860-696-2550
  • Fax: 860-696-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCT

VIII. Authorized Official

Name: MR. ERIC SMULLEN
Title or Position: EXECUTIVE DIRECTOR
Credential: PT
Phone: 860-696-2550