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General NPI Number Information
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NPI Number | 1770562720
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Entity Type | Organization
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Legal Business Name | WOODBURY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 264 MAIN ST S STE 200
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City | WOODBURY
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State | CT
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Zip | 06798
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Country | US
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Telephone | 203-263-0002
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Fax | 203-263-0090
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Provider Business Mailing Address
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Address Line | 264 MAIN ST S STE 200
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City | WOODBURY
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State | CT
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Zip | 06798
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Country | US
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Telephone | 203-263-0002
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Fax | 203-263-0090
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Authorized Official
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Title or Position | RPT
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Name | MRS. MAUREEN MUNSON BETTE
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Credential |
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Telephone | 203-263-0002
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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 | 001680
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License Number State | CT
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