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General NPI Number Information
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NPI Number | 1043488059
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC PHYSICAL THERAPY OF SOUTHERN NEW ENGLAND LLC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 7 CLINIC DR
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City | NORWICH
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State | CT
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Zip | 06360-2915
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Country | US
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Telephone | 860-887-6408
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Fax | 860-887-6592
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Provider Business Mailing Address
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Address Line | 7 CLINIC DR
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City | NORWICH
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State | CT
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Zip | 06360-2915
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Country | US
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Telephone | 860-887-6408
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Fax | 860-887-6592
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | STEVEN KENNETH GAMBLE
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Credential | MS, PT
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Telephone | 860-887-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 003827
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License Number State | CT
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