Healthcare Provider Details

I. General information

NPI: 1770562720
Provider Name (Legal Business Name): WOODBURY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 MAIN ST S STE 200
WOODBURY CT
06798
US

IV. Provider business mailing address

264 MAIN ST S STE 200
WOODBURY CT
06798
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-0002
  • Fax: 203-263-0090
Mailing address:
  • Phone: 203-263-0002
  • Fax: 203-263-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number001680
License Number StateCT

VIII. Authorized Official

Name: MRS. MAUREEN MUNSON BETTE
Title or Position: RPT
Credential:
Phone: 203-263-0002