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General NPI Number Information
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NPI Number | 1093881559
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL REHAB & FITNESS LLC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 350 LITCHFIELD RD
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City | NEW MILFORD
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State | CT
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Zip | 06776-2003
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Country | US
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Telephone | 860-355-5373
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Fax | 860-355-8171
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Provider Business Mailing Address
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Address Line | 350 LITCHFIELD RD
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City | NEW MILFORD
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State | CT
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Zip | 06776-2003
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Country | US
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Telephone | 860-355-5373
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Fax | 860-355-8171
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Authorized Official
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Title or Position | OWNER
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Name | MS. GAIL THERESA HENDERSON
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Credential | MS,ATC,PT,CCRP
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Telephone | 860-355-5373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 4346
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License Number State | CT
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