Healthcare Provider Details

I. General information

NPI: 1114363348
Provider Name (Legal Business Name): MEDICAL MASSAGE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 SILAS DEANE HWY SUITE 202
ROCKY HILL CT
06067-2332
US

IV. Provider business mailing address

2049 SILAS DEANE HWY SUITE 202
ROCKY HILL CT
06067-2332
US

V. Phone/Fax

Practice location:
  • Phone: 860-721-0249
  • Fax:
Mailing address:
  • Phone: 860-721-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number6568
License Number StateCT

VIII. Authorized Official

Name: LAWRENCE R JOYNER
Title or Position: PRESIDENT
Credential: LMT. MMP
Phone: 860-721-0249