Healthcare Provider Details

I. General information

NPI: 1356884522
Provider Name (Legal Business Name): UNIFIED THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 SULLIVAN AVE SUITE 7
SOUTH WINDSOR CT
06074-2007
US

IV. Provider business mailing address

915 SULLIVAN AVE STE 3
SOUTH WINDSOR CT
06074-2165
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-2335
  • Fax:
Mailing address:
  • Phone: 860-644-2335
  • Fax: 888-974-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number007148
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4793
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number002397
License Number StateCT

VIII. Authorized Official

Name: HOWARD GREGORY VENZIE
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: DPT
Phone: 860-644-2335