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General NPI Number Information
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NPI Number | 1134491574
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Entity Type | Organization
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Legal Business Name | OTHOPEDIC ASSOCIATES PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 2928 MAIN ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-1007
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Country | US
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Telephone | 860-549-8975
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Fax |
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Provider Business Mailing Address
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Address Line | 181 PATRICIA M GENOVA DR
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City | NEWINGTON
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State | CT
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Zip | 06111-1500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LAUREN FRISBIE
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Credential |
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Telephone | 860-696-2502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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