MEDICARE: REGIONAL PHYSICAL MANUAL THERAPY

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

General Provider Information

NPI Number	:	1194853887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL PHYSICAL MANUAL THERAPY

Provider Business Mailing Address
First Line	:	1 NORTHWESTERN DR
Second Line	:	SUITE 101
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3400
Country	:	US
Telephone Number	:	860-243-6571
Fax Number	:	860-243-6579

Provider Business Practice Location Address
First Line	:	1 NORTHWESTERN DR
Second Line	:	SUITE 101
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3400
Country	:	US
Telephone Number	:	860-243-6571
Fax Number	:	860-243-6579

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MATTHEW CONNELL-GIAMMATTEO
Credential	:
Telephone Number	:	860-243-6571

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	04/18/2012

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Directions to “REGIONAL PHYSICAL MANUAL THERAPY ” Practice Location

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