Provider Demographics
NPI:1174852479
Name:ALLSTAR THERAPY, LLC
Entity Type:Organization
Organization Name:ALLSTAR THERAPY, LLC
Other - Org Name:APPLE REHAB SPORT & SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-677-2934
Mailing Address - Street 1:21 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2097
Mailing Address - Country:US
Mailing Address - Phone:860-677-2934
Mailing Address - Fax:860-678-7827
Practice Address - Street 1:51 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3821
Practice Address - Country:US
Practice Address - Phone:860-677-2934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002951261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy