Healthcare Provider Details

I. General information

NPI: 1194028779
Provider Name (Legal Business Name): FISIO PHYSICAL THERAPY & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MOUNT PLEASANT RD
NEWTOWN CT
06470-1438
US

IV. Provider business mailing address

33 PAUGUSSETT RD SUITE B
SANDY HOOK CT
06482-1503
US

V. Phone/Fax

Practice location:
  • Phone: 203-270-2977
  • Fax: 203-841-1245
Mailing address:
  • Phone: 203-947-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KARIN WILLIAMS LABANCA
Title or Position: OWNER
Credential: PT, DPT
Phone: 203-270-2977