Provider Demographics
NPI:1376760892
Name:ELLINGTON PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ELLINGTON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:860-265-2392
Mailing Address - Street 1:175 WEST ROAD
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029
Mailing Address - Country:US
Mailing Address - Phone:860-896-9275
Mailing Address - Fax:860-896-9265
Practice Address - Street 1:175 WEST RD
Practice Address - Street 2:SUITE 6A
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3730
Practice Address - Country:US
Practice Address - Phone:860-896-9275
Practice Address - Fax:860-896-9265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy