Provider Demographics
NPI:1114979226
Name:CARLSON THERAPY NETWORK, PC
Entity Type:Organization
Organization Name:CARLSON THERAPY NETWORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:860-799-6320
Mailing Address - Street 1:116 DANBURY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3442
Mailing Address - Country:US
Mailing Address - Phone:860-799-6320
Mailing Address - Fax:860-799-6621
Practice Address - Street 1:116 DANBURY RD STE 5
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3442
Practice Address - Country:US
Practice Address - Phone:860-799-6320
Practice Address - Fax:860-799-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X, 225XH1200X, 225100000X, 225XH1200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004210093Medicaid
CTOV5480OtherHEALTHNET GROUP NUMBER
CTMPIN# 1764442OtherUNITED HEALTH CARE OF NE
CT83895OtherAETNA
CTANC589OtherOXFORD HEALTH PLANS
1543398OtherCIGNA
CTCG7959OtherMEDICARE RAILROAD GROUP
CT83895OtherAETNA
CTC02446Medicare PIN
CTCG7959OtherMEDICARE RAILROAD GROUP