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General NPI Number Information
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NPI Number | 1245837384
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Entity Type | Organization
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Legal Business Name | CONNECTICUT BACK CENTER LLC
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 460 HARTFORD TPKE STE B
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City | VERNON
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State | CT
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Zip | 06066-4847
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Country | US
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Telephone | 860-872-6229
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Fax | 860-872-6252
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Provider Business Mailing Address
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Address Line | 460 HARTFORD TPKE STE B
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City | VERNON
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State | CT
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Zip | 06066-4847
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Country | US
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Telephone | 860-872-6229
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Fax | 860-872-6252
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Authorized Official
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Title or Position | OWNER
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Name | JESSE EISLER
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Credential | MD
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Telephone | 860-268-3349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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