Provider Demographics
NPI:1235202821
Name:UNIVERSITY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-768-5335
Mailing Address - Street 1:200 BLOOMFIELD AVE
Mailing Address - Street 2:ATHLETIC COMPLEX
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1545
Mailing Address - Country:US
Mailing Address - Phone:860-768-5335
Mailing Address - Fax:860-768-7892
Practice Address - Street 1:200 BLOOMFIELD AVE
Practice Address - Street 2:ATHLETIC COMPLEX
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1545
Practice Address - Country:US
Practice Address - Phone:860-768-5335
Practice Address - Fax:860-768-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy