Provider Demographics
NPI:1699950014
Name:ORTHOPEDIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ORTHOPEDIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-621-7389
Mailing Address - Street 1:360 N MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-621-7389
Mailing Address - Fax:860-621-2586
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2500
Practice Address - Country:US
Practice Address - Phone:860-620-9453
Practice Address - Fax:860-620-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty