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General NPI Number Information
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NPI Number | 1255121158
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Entity Type | Organization
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Legal Business Name | PHOENIX THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 185 CENTER ST STE E
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City | WALLINGFORD
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State | CT
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Zip | 06492-4179
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Country | US
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Telephone | 203-514-9787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 562
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City | DURHAM
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State | CT
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Zip | 06422-0562
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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 | OWNER
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Name | JESSICA L CRONK
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Credential |
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Telephone | 203-214-4332
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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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