Healthcare Provider Details

I. General information

NPI: 1023065216
Provider Name (Legal Business Name): CONNECTICUT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 CAMPBELL AVE
WEST HAVEN CT
06516-3715
US

IV. Provider business mailing address

665 PHILADELPHIA ST ATTENTION: SUSIE SMELTZER
INDIANA PA
15701-3941
US

V. Phone/Fax

Practice location:
  • Phone: 203-931-9698
  • Fax: 203-931-4559
Mailing address:
  • Phone: 724-465-3496
  • Fax: 724-465-3726

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: MR. DENNIS FITZPATRICK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 610-644-7824