Basic Information
Provider Information | |||||||||
NPI: | 1124566823 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PROFESSIONAL THERAPY CONTRACTING SERVICES OF CT, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 2142 UTOPIA PKWY | ||||||||
Address2: |   | ||||||||
City: | WHITESTONE | ||||||||
State: | NY | ||||||||
PostalCode: | 113574142 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7188196805 | ||||||||
FaxNumber: | 3478419109 | ||||||||
Practice Location | |||||||||
Address1: | 329 RIVERSIDE AVE | ||||||||
Address2: |   | ||||||||
City: | WESTPORT | ||||||||
State: | CT | ||||||||
PostalCode: | 068804810 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2035576477 | ||||||||
FaxNumber: | 2035576481 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/02/2017 | ||||||||
LastUpdateDate: | 02/02/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BRUSH | ||||||||
AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 7188196805 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.