Basic Information
| Provider Information | |||||||||
| NPI: | 1700216967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMANCE PHYSICAL THERAPY OF HAMDEN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 POST RD W | ||||||||
| Address2: | |||||||||
| City: | WESTPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068804701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034220679 | ||||||||
| FaxNumber: | 2034220931 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 POST RD W | ||||||||
| Address2: | |||||||||
| City: | WESTPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068804701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034220679 | ||||||||
| FaxNumber: | 2034220931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2013 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | WILKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2034220679 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PERFORMANCE HEALTH CARE MANAGEMENT | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7440 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.