Healthcare Provider Details

I. General information

NPI: 1134261563
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPAEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MAIN STREET EXT STE 200
WALLINGFORD CT
06492-2434
US

IV. Provider business mailing address

85 BARNES RD
WALLINGFORD CT
06492-1832
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax:
Mailing address:
  • Phone: 203-741-6547
  • Fax: 203-741-6575

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: MRS. KATHY M OLIVEIRA-GAGNON
Title or Position: DIRECTOR OF ADMIN/CREDENTIALING
Credential:
Phone: 860-685-8941