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General NPI Number Information
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NPI Number | 1619783495
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Entity Type | Organization
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Legal Business Name | PRESTIGE REHAB CT PLLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 36 RUSS ST FL 3
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City | HARTFORD
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State | CT
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Zip | 06106-1520
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Country | US
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Telephone | 855-678-8887
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Fax | 855-678-8887
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Provider Business Mailing Address
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Address Line | 36 RUSS ST FL 3
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City | HARTFORD
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State | CT
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Zip | 06106-1520
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Country | US
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Telephone | 855-678-8887
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Fax | 855-678-8887
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Authorized Official
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Title or Position | CEO
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Name | DANIEL REIZIS
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Credential | PT
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Telephone | 908-670-7573
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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 |
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License Number State |
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