Provider Demographics
NPI:1083075832
Name:TOTAL BODY PHYSICAL THERAPY, LLP
Entity type:Organization
Organization Name:TOTAL BODY PHYSICAL THERAPY, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC, LAT
Authorized Official - Phone:203-957-8162
Mailing Address - Street 1:166 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5725
Mailing Address - Country:US
Mailing Address - Phone:203-957-8162
Mailing Address - Fax:203-957-8165
Practice Address - Street 1:166 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5725
Practice Address - Country:US
Practice Address - Phone:203-957-8162
Practice Address - Fax:203-957-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006539225100000X
CT008189225100000X
2255A2300X
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1164524351OtherINDIVIDUAL NPI
CT1215990551OtherINDIVIDUAL NPI
CT1194913160OtherINDIVIDUAL NPI
CT1215990551OtherINDIVIDUAL NPI
CTD400299018Medicare PIN
CTD100299013Medicare PIN