Provider Demographics
NPI:1386740751
Name:CONNAL PHYSICAL THERAPY GROUP LLC
Entity type:Organization
Organization Name:CONNAL PHYSICAL THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-683-0080
Mailing Address - Street 1:6 POQUONOCK AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2507
Mailing Address - Country:US
Mailing Address - Phone:860-683-0080
Mailing Address - Fax:860-683-2614
Practice Address - Street 1:6 POQUONOCK AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2507
Practice Address - Country:US
Practice Address - Phone:860-683-0080
Practice Address - Fax:860-683-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
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
C02659Medicare ID - Type Unspecified