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General NPI Number Information
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NPI Number | 1336392950
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Entity Type | Organization
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Legal Business Name | PERSONAL WELLNESS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 35 BOSTON ST
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City | GUILFORD
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State | CT
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Zip | 06437-2817
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Country | US
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Telephone | 203-809-7813
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Fax |
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Provider Business Mailing Address
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Address Line | 817 TOTOKET RD
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City | NORTHFORD
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State | CT
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Zip | 06472-1458
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Country | US
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Telephone | 203-484-0601
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KAREN E AUSTIN
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Credential | PT
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Telephone | 203-809-7813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 004483
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License Number State | CT
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