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General NPI Number Information
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NPI Number | 1174805600
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Entity Type | Organization
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Legal Business Name | FORMULA PHYSICAL THERAPY, CORP
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Dates
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Enumeration Date | 09/11/2011
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Last Update Date | 09/11/2011
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Provider Practice Location Address
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Address Line | 27 LOIS ST
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City | NORWALK
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State | CT
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Zip | 06851-4404
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Country | US
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Telephone | 203-642-3813
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Fax | 203-642-3815
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Provider Business Mailing Address
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Address Line | 27 LOIS ST
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City | NORWALK
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State | CT
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Zip | 06851-4404
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Country | US
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Telephone | 203-642-3813
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Fax | 203-642-3815
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DANIELLE M FAUX
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Credential | PT
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Telephone | 203-642-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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