MEDICARE: FISIO PHYSICAL THERAPY & WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080006688CT05	OTHER	CT	ANTHEM
2	776575	OTHER	CT	OPTUM- UNITED HEALTH CARE
3	0402615	OTHER	CT	CIGNA
4	0402615	OTHER	CT	AETNA

General Provider Information

NPI Number	:	1194028779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISIO PHYSICAL THERAPY & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	33 PAUGUSSETT RD
Second Line	:	SUITE B
City	:	SANDY HOOK
State	:	CT
Zip	:	06482-1503
Country	:	US
Telephone Number	:	203-947-2849
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 MOUNT PLEASANT RD
Second Line	:
City	:	NEWTOWN
State	:	CT
Zip	:	06470-1438
Country	:	US
Telephone Number	:	203-270-2977
Fax Number	:	203-841-1245

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KARIN WILLIAMS LABANCA
Credential	:	PT, DPT
Telephone Number	:	203-270-2977

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	03/17/2018

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