Provider Demographics
NPI:1194853887
Name:REGIONAL PHYSICAL MANUAL THERAPY
Entity Type:Organization
Organization Name:REGIONAL PHYSICAL MANUAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELL-GIAMMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-243-6571
Mailing Address - Street 1:1 NORTHWESTERN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3400
Mailing Address - Country:US
Mailing Address - Phone:860-243-6571
Mailing Address - Fax:860-243-6579
Practice Address - Street 1:1 NORTHWESTERN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3400
Practice Address - Country:US
Practice Address - Phone:860-243-6571
Practice Address - Fax:860-243-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty