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General NPI Number Information
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NPI Number | 1316562994
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Entity Type | Organization
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Legal Business Name | BARBELL PHYSICAL THERAPY AND PERFORMANCE, LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 87 WASHINGTON AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1705
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Country | US
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Telephone | 860-817-4612
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Fax |
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Provider Business Mailing Address
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Address Line | 10 AVALON DR UNIT 3232
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City | MILFORD
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State | CT
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Zip | 06460-8576
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Country | US
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Telephone | 860-817-4612
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN VANNIEUWENHUYZE
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Credential | DPT
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Telephone | 860-817-4612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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