Provider Demographics
NPI:1194028779
Name:FISIO PHYSICAL THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:FISIO PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:LABANCA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:203-270-2977
Mailing Address - Street 1:33 PAUGUSSETT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1503
Mailing Address - Country:US
Mailing Address - Phone:203-947-2849
Mailing Address - Fax:
Practice Address - Street 1:141 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1438
Practice Address - Country:US
Practice Address - Phone:203-270-2977
Practice Address - Fax:203-841-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006688CT05OtherANTHEM
CT776575OtherOPTUM- UNITED HEALTH CARE
CT0402615OtherCIGNA
CT0402615OtherAETNA
CT22740111960Medicare PIN