Provider Demographics
NPI:1043436488
Name:CONNECTICUT SOUNDSIDE PHYSICAL THERAPY HOMECARE, PC
Entity Type:Organization
Organization Name:CONNECTICUT SOUNDSIDE PHYSICAL THERAPY HOMECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KALENDERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-759-9717
Mailing Address - Street 1:196 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1832
Mailing Address - Country:US
Mailing Address - Phone:516-759-9717
Mailing Address - Fax:
Practice Address - Street 1:184 NEW STATE RD
Practice Address - Street 2:APT 38
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-7943
Practice Address - Country:US
Practice Address - Phone:860-643-9926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007602261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy