Healthcare Provider Details

I. General information

NPI: 1629116249
Provider Name (Legal Business Name): FARMINGTON VALLEY PHYSICAL THERAPY AND SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S MAIN ST
UNIONVILLE CT
06085-1255
US

IV. Provider business mailing address

112 S MAIN ST
UNIONVILLE CT
06085-1255
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-0223
  • Fax: 860-673-7605
Mailing address:
  • Phone: 860-673-0223
  • Fax: 860-673-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number004916
License Number StateCT

VIII. Authorized Official

Name: MRS. BOGUSLAWA JOLANTA BADON
Title or Position: PRESIDENT
Credential: RPT
Phone: 860-673-0223