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General NPI Number Information
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NPI Number | 1609025394
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Entity Type | Organization
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Legal Business Name | CENTERED HEALTH PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 1477 PARK ST SUITE 14
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City | HARTFORD
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State | CT
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Zip | 06106-2235
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Country | US
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Telephone | 860-648-0659
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Fax |
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Provider Business Mailing Address
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Address Line | 1477 PARK ST SUITE 14
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City | HARTFORD
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State | CT
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Zip | 06106-2235
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Country | US
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Telephone | 860-648-0659
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY MAIETTA
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Credential | MSPT
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Telephone | 860-648-0659
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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 | 07875
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License Number State | CT
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