Basic Information
| Provider Information | |||||||||
| NPI: | 1831241926 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEMPLE HEALTH SERVICES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TEMPLE PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 GEORGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034985980 | ||||||||
| FaxNumber: | 2034985999 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 GEORGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034985980 | ||||||||
| FaxNumber: | 2034985999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | ELIA | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2034073576 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.