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General NPI Number Information
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NPI Number | 1538498902
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Entity Type | Organization
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Legal Business Name | MD PHYSICAL THERAPY ASSOCIATES
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 689 CAMPBELL AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-3711
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Country | US
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Telephone | 203-932-6481
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Fax | 203-932-4051
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Provider Business Mailing Address
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Address Line | 689 CAMPBELL AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-3711
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Country | US
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Telephone | 203-932-6481
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Fax | 203-932-4051
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. ANURUDDHA WALALIYADDA
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Credential | M.D.
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Telephone | 203-932-6481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 9446592000
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License Number State | CT
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