Healthcare Provider Details

I. General information

NPI: 1801962444
Provider Name (Legal Business Name): RIFKIN PHYSICAL THERAPY & LYMPHEDEMA CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 WATERBURY RD
PROSPECT CT
06712
US

IV. Provider business mailing address

21 HOLLEY LANE
PROSPECT CT
06712
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-6569
  • Fax: 203-758-0443
Mailing address:
  • Phone: 203-758-6569
  • Fax: 203-758-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMELITA RIFKIN
Title or Position: OWNER
Credential: MS PT CLT LANA
Phone: 203-758-6569