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General NPI Number Information
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NPI Number | 1700895729
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Entity Type | Organization
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Legal Business Name | EASTERN CONNECTICUT REHABILI
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1666 ROUTE 12
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City | GALES FERRY
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State | CT
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Zip | 06335
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Country | US
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Telephone | 860-889-1948
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Fax | 860-537-5926
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Provider Business Mailing Address
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Address Line | PO BOX 425
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City | DAYVILLE
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State | CT
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Zip | 06241-0425
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Country | US
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Telephone | 860-889-1948
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Fax | 860-889-1101
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Authorized Official
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Title or Position | OWNER EXECUTIVE DIRECTOR
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Name | MR. CARL REMI MAILHOT
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Credential |
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Telephone | 860-889-1948
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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 |
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License Number State | CT
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