Healthcare Provider Details

I. General information

NPI: 1639502321
Provider Name (Legal Business Name): RYDERS REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ORONOQUE LN FIRST FLOOR
STRATFORD CT
06614-1379
US

IV. Provider business mailing address

999 ORONOQUE LN FIRST FLOOR
STRATFORD CT
06614-1379
US

V. Phone/Fax

Practice location:
  • Phone: 203-870-2022
  • Fax: 203-386-1144
Mailing address:
  • Phone: 203-870-2022
  • Fax: 203-386-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FRANK J RACCIO JR.
Title or Position: DIRECTOR OF REHABILITATION
Credential: PTA, MS, LNHA
Phone: 203-870-2022