Basic Information
| Provider Information | |||||||||
| NPI: | 1497184246 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SELECT PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061071933 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 131 KENT RD | ||||||||
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| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067763485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603503330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2013 | ||||||||
| LastUpdateDate: | 11/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | GUZZE | ||||||||
| AuthorizedOfficialFirstName: | ROXANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL SERVICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8605612624 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 009881 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.