Healthcare Provider Details

I. General information

NPI: 1396002184
Provider Name (Legal Business Name): WINDSOR PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 POQUONOCK AVE
WINDSOR CT
06095-2551
US

IV. Provider business mailing address

PO BOX 466
CANTON CT
06019-0466
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
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL DEVLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-693-6226