Provider Demographics
NPI:1407903545
Name:CENTER REHABILITATION & SPORTS THERAPY LLC
Entity Type:Organization
Organization Name:CENTER REHABILITATION & SPORTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:203-882-9384
Mailing Address - Street 1:155 HILL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3192
Mailing Address - Country:US
Mailing Address - Phone:203-882-9384
Mailing Address - Fax:203-882-9385
Practice Address - Street 1:155 HILL ST
Practice Address - Street 2:SUITE B
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3192
Practice Address - Country:US
Practice Address - Phone:203-882-9384
Practice Address - Fax:203-882-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4793261QP2000X
CT004793332B00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02579Medicare PIN