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General NPI Number Information
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NPI Number | 1528275872
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Entity Type | Organization
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Legal Business Name | COMMUNITY PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 421 WOLCOTT RD UNIT C
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City | WOLCOTT
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State | CT
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Zip | 06716-2661
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Country | US
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Telephone | 203-879-0107
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Fax |
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Provider Business Mailing Address
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Address Line | 360 N MAIN ST STE 9
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2503
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Country | US
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Telephone | 860-621-7389
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL T DALEY
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Credential | P.T.
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Telephone | 860-621-7389
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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 | 002030
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License Number State | CT
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