Healthcare Provider Details

I. General information

NPI: 1386740751
Provider Name (Legal Business Name): CONNAL PHYSICAL THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 POQUONOCK AVE SUITE 11
WINDSOR CT
06095-2507
US

IV. Provider business mailing address

6 POQUONOCK AVE SUITE 11
WINDSOR CT
06095-2507
US

V. Phone/Fax

Practice location:
  • Phone: 860-683-0080
  • Fax: 860-683-2614
Mailing address:
  • Phone: 860-683-0080
  • Fax: 860-683-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ALISON LINDA CLARK
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-683-0080