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General NPI Number Information
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NPI Number | 1639441439
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Entity Type | Organization
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Legal Business Name | CONNECTICUT PHYSICAL THERAPY SPECIALISTS LLC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 11 MILL POND DR
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City | GRANBY
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State | CT
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Zip | 06035-2628
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Country | US
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Telephone | 860-413-9969
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 268
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City | GRANBY
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State | CT
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Zip | 06035-0268
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Country | US
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Telephone | 860-413-9969
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. DAVID J BOSTIC
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Credential | PT
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Telephone | 860-944-8618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 003110
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License Number State | CT
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