Basic Information
| Provider Information | |||||||||
| NPI: | 1790084390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARLSON THERAPY NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 NEWTOWN RD # A | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068104194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037390765 | ||||||||
| FaxNumber: | 2037390792 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 NEWTOWN RD # A | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068104194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037390765 | ||||||||
| FaxNumber: | 2037390792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2011 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2037390765 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X | 006116 | CT | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 225XH1200X | 000144 | CT | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.