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General NPI Number Information
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NPI Number | 1528191426
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Entity Type | Organization
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Legal Business Name | AMITY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 1 BRADLEY RD SUITE #801
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2285
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Country | US
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Telephone | 203-389-4593
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Fax | 203-389-4609
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Provider Business Mailing Address
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Address Line | 1 BRADLEY RD SUITE #801
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2285
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Country | US
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Telephone | 203-389-4593
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Fax | 203-389-4609
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Authorized Official
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Title or Position | DIRECTOR PHYSICAL THERAPIST
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Name | MICHAEL F DOW
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Credential | MSPT
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Telephone | 203-389-4593
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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 | CT008058
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CT006646
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License Number State | CT
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