Healthcare Provider Details

I. General information

NPI: 1063688042
Provider Name (Legal Business Name): INTEGRATED SPORTS THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 POST RD E STE 209
WESTPORT CT
06880-3414
US

IV. Provider business mailing address

180 POST ROAD EAST SUITE 209
WESTPORT CT
06880-3414
US

V. Phone/Fax

Practice location:
  • Phone: 203-292-9353
  • Fax: 203-292-9353
Mailing address:
  • Phone: 203-292-9353
  • Fax: 203-292-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001725
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007391
License Number StateCT

VIII. Authorized Official

Name: DR. EDWARD J ZEBRO
Title or Position: PRESIDENT / OWNER
Credential: D.C.
Phone: 203-292-9353