Provider Demographics
NPI:1134295678
Name:CROSSROADS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CROSSROADS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:860-228-0194
Mailing Address - Street 1:106 ROUTE 66 EAST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237
Mailing Address - Country:US
Mailing Address - Phone:860-228-0194
Mailing Address - Fax:860-228-2694
Practice Address - Street 1:106 ROUTE 66 EAST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237
Practice Address - Country:US
Practice Address - Phone:860-228-0194
Practice Address - Fax:860-228-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty