Basic Information
| Provider Information | |||||||||
| NPI: | 1679653281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAPIN & HAVLICEK PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 PRINCE ST | ||||||||
| Address2: | SUITE 402B | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037527878 | ||||||||
| FaxNumber: | 2037764989 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 PRINCE ST | ||||||||
| Address2: | SUITE 402B | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037527878 | ||||||||
| FaxNumber: | 2037764989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHAPIN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2037527878 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 50HAVLICECT01 | 01 | CT | BCBS | OTHER | CG2786 | 01 | CT | RAILROAD MEDICARE | OTHER | 0578042 | 01 | AETNA | OTHER | 0114801 | 01 | ORTHONET | OTHER | 2V4683 | 01 | HEALTHNET | OTHER | 2V8124 | 01 | HEALTHNET 9/1/06 | OTHER |