Provider Demographics
NPI:1235351289
Name:PHYSICAL THERAPY SERVICES OF GUILFORD LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF GUILFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-315-7727
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2911
Mailing Address - Country:US
Mailing Address - Phone:203-315-7727
Mailing Address - Fax:203-315-7757
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2911
Practice Address - Country:US
Practice Address - Phone:203-315-7727
Practice Address - Fax:203-315-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2013-08-08
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
CTCO2493Medicare PIN