Provider Demographics
NPI:1407062227
Name:NEW CANAAN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NEW CANAAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR-PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HRISTON ZECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-966-5752
Mailing Address - Street 1:45 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5330
Mailing Address - Country:US
Mailing Address - Phone:203-966-5752
Mailing Address - Fax:203-966-7507
Practice Address - Street 1:45 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5330
Practice Address - Country:US
Practice Address - Phone:203-966-5752
Practice Address - Fax:203-966-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007011225100000X
CT002635225100000X
CT007229225100000X
CT005123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT731941OtherPROVIDER ID
CTCU9817OtherHEALTHNET
CTANC1555OtherPROVIDER ID
CTANC1555OtherPROVIDER ID
CTC02542Medicare ID - Type UnspecifiedPROVIDER ID