Provider Demographics
NPI:1194282004
Name:PERFORMANCE PHYSICAL THERAPY OF NEW CANAAN, PLLC
Entity type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY OF NEW CANAAN, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-553-7626
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-0402
Mailing Address - Country:US
Mailing Address - Phone:203-553-7626
Mailing Address - Fax:
Practice Address - Street 1:16 CROSS ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4831
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:203-621-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty