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General NPI Number Information
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NPI Number | 1245466846
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Entity Type | Organization
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Legal Business Name | CMC PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 64 BARNABAS RD UNIT 4
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City | NEWTOWN
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State | CT
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Zip | 06470-1259
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Country | US
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Telephone | 203-270-1370
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Fax | 203-270-1417
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Provider Business Mailing Address
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Address Line | 64 BARNABAS RD UNIT 4
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City | NEWTOWN
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State | CT
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Zip | 06470-1259
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Country | US
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Telephone | 203-270-1370
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Fax | 203-270-1417
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CATHLEEN MARIE CLARK
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Credential | MPT
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Telephone | 203-270-1370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 004454
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License Number State | CT
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