Healthcare Provider Details

I. General information

NPI: 1336225036
Provider Name (Legal Business Name): WILTON PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HUBBARD RD
WILTON CT
06897-3045
US

IV. Provider business mailing address

23 HUBBARD RD
WILTON CT
06897-3045
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-5623
  • Fax: 203-762-9344
Mailing address:
  • Phone: 203-762-5623
  • Fax: 203-762-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY M. GRABIEC
Title or Position: OWNER
Credential: MSPT
Phone: 203-762-5623