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General NPI Number Information
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NPI Number | 1417176462
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Entity Type | Organization
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Legal Business Name | WALLINGFORD PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 350 CENTER ST SUITE 104
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City | WALLINGFORD
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State | CT
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Zip | 06492-4243
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Country | US
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Telephone | 203-265-2500
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Fax | 203-265-9222
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Provider Business Mailing Address
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Address Line | 350 CENTER ST SUITE 104
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City | WALLINGFORD
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State | CT
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Zip | 06492-4243
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Country | US
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Telephone | 203-265-2500
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Fax | 203-265-9222
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Authorized Official
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Title or Position | OWNER
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Name | LYNN VAUGHAN
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Credential | RPT
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Telephone | 203-265-2500
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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 | 001746
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License Number State | CT
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