Provider Demographics
NPI:1891221370
Name:CONNECT PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:CONNECT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:959-209-4318
Mailing Address - Street 1:125 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1561
Mailing Address - Country:US
Mailing Address - Phone:959-209-4318
Mailing Address - Fax:
Practice Address - Street 1:777 ECHO LAKE RD
Practice Address - Street 2:SUITE I
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-1637
Practice Address - Country:US
Practice Address - Phone:959-209-4318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty