Provider Demographics
NPI:1386753176
Name:COMPREHENSIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:COMPREHENSIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-233-9922
Mailing Address - Street 1:609 FARMINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3081
Mailing Address - Country:US
Mailing Address - Phone:860-233-9922
Mailing Address - Fax:860-233-2067
Practice Address - Street 1:609 FARMINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3081
Practice Address - Country:US
Practice Address - Phone:860-233-9922
Practice Address - Fax:860-233-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty