MEDICARE: UNIVERSITY PHYSICAL THERAPY 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1235202821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	200 BLOOMFIELD AVE
Second Line	:	ATHLETIC COMPLEX
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1545
Country	:	US
Telephone Number	:	860-768-5335
Fax Number	:	860-768-7892

Provider Business Practice Location Address
First Line	:	200 BLOOMFIELD AVE
Second Line	:	ATHLETIC COMPLEX
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1545
Country	:	US
Telephone Number	:	860-768-5335
Fax Number	:	860-768-7892

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN SCOTT LEARD
Credential	:
Telephone Number	:	860-768-5335

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	12/17/2013

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