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General NPI Number Information
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NPI Number | 1407343890
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Entity Type | Organization
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Legal Business Name | STANGO PHYSICAL THERAPY AT HOME, LLC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 58 LOOP RD
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City | WATERTOWN
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State | CT
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Zip | 06795-1552
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Country | US
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Telephone | 203-206-4576
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Fax | 860-417-2457
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Provider Business Mailing Address
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Address Line | 58 LOOP RD
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City | WATERTOWN
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State | CT
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Zip | 06795-1552
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Country | US
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Telephone | 203-206-4576
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Fax | 860-417-2457
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL C. STANGO
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Credential | MSPT
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Telephone | 203-206-4576
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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 | 008214
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License Number State | CT
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