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General NPI Number Information
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NPI Number | 1417156399
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Entity Type | Organization
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Legal Business Name | PATHWAYS PHYSICAL THERAPY,LLC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 241 BROAD ST
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City | MERIDEN
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State | CT
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Zip | 06450-5877
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Country | US
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Telephone | 203-440-9880
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Fax | 203-440-9881
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Provider Business Mailing Address
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Address Line | 241 BROAD ST
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City | MERIDEN
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State | CT
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Zip | 06450-5877
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Country | US
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Telephone | 203-440-9880
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Fax | 203-440-9881
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLY JEAN ANETRELLA
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Credential | P.T.
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Telephone | 203-440-9880
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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 | 006419
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License Number State | CT
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