MEDICARE: PREFERRED THERAPY OUTPATIENT SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	261QR0400X	Rehabilitation Clinic/Center
4	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1871163451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED THERAPY OUTPATIENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	850 SILAS DEANE HWY
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-3443
Country	:	US
Telephone Number	:	860-610-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PARK LAWN DR
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-1041
Country	:	US
Telephone Number	:	203-790-8520
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MR. DAVID COLELLA
Credential	:
Telephone Number	:	860-610-0400

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	09/08/2021

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