Provider Demographics
NPI:1366564106
Name:PHYSICIANS PHYSICAL THERAPY
Entity type:Organization
Organization Name:PHYSICIANS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIRES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-937-6150
Mailing Address - Street 1:544 CAMPBELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:203-937-6150
Mailing Address - Fax:203-937-8517
Practice Address - Street 1:544 CAMPBELL AVENUE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-937-6150
Practice Address - Fax:203-937-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ANC1174OtherOXFORD
Q33N61OtherEMPIRE BCBS
0019701OtherORTHONET HEALTHNET
19701OtherCIGNA
50PHYS1C1CT01OtherANTHEM BCBS
130002OtherAETNA
6014071OtherCONNECTICARE
0V1092OtherACS HEALTHNET
ANC1174OtherOXFORD
6014071OtherCONNECTICARE