Provider Demographics
NPI:1053684118
Name:GAITWAY PHYSICAL THERAPY OF CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:GAITWAY PHYSICAL THERAPY OF CONNECTICUT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:516-658-8252
Mailing Address - Street 1:35 EARL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1708
Mailing Address - Country:US
Mailing Address - Phone:516-623-4769
Mailing Address - Fax:516-771-0621
Practice Address - Street 1:6 ARCADIA LANE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4437
Practice Address - Country:US
Practice Address - Phone:516-623-4769
Practice Address - Fax:516-771-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty