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General NPI Number Information
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NPI Number | 1336466549
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Entity Type | Organization
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Legal Business Name | FALL BUSTERS, LLC
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 730 HOPMEADOW ST REAR LOT
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City | SIMSBURY
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State | CT
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Zip | 06070-2225
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Country | US
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Telephone | 860-325-0786
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1023
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City | SIMSBURY
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State | CT
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Zip | 06070-7323
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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 | PHYSICAL THERAPIST & OWNER
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Name | DEAN TEITELBAUM
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Credential | PT, DPT
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Telephone | 860-408-9818
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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 | 007319
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License Number State | CT
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