Healthcare Provider Details

I. General information

NPI: 1316562994
Provider Name (Legal Business Name): BARBELL PHYSICAL THERAPY AND PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17A HERITAGE CIR
SOUTHBURY CT
06488-1423
US

IV. Provider business mailing address

157 CHURCH ST FL 19
NEW HAVEN CT
06510-2100
US

V. Phone/Fax

Practice location:
  • Phone: 203-679-1476
  • Fax:
Mailing address:
  • Phone: 203-679-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN VANNIEUWENHUYZE
Title or Position: OWNER
Credential: DPT
Phone: 860-817-4612