Provider Demographics
NPI:1336466549
Name:FALL BUSTERS, LLC
Entity Type:Organization
Organization Name:FALL BUSTERS, LLC
Other - Org Name:STRIDE TO HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:860-408-9818
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-7323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 HOPMEADOW ST
Practice Address - Street 2:REAR LOT
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2225
Practice Address - Country:US
Practice Address - Phone:860-325-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007319261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy