Provider Demographics
NPI:1154400927
Name:JOHN JARECKI PHYSICAL THERAPY SERVICES LLC
Entity type:Organization
Organization Name:JOHN JARECKI PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARECKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-256-4733
Mailing Address - Street 1:1735 POST RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5782
Mailing Address - Country:US
Mailing Address - Phone:203-256-4733
Mailing Address - Fax:203-256-4736
Practice Address - Street 1:1735 POST RD
Practice Address - Street 2:SUITE 7
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5782
Practice Address - Country:US
Practice Address - Phone:203-256-4733
Practice Address - Fax:203-256-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004349261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V1340OtherHEALTHNET
CT080004349CT01OtherANTHEM BC/BS
CT0115901OtherORTHONET
CT080004349CT01OtherANTHEM BC/BS