Provider Demographics
NPI:1417374463
Name:INTEGRATIVE WELLNESS AND PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS AND PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AYELET
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELL-GIAMMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,PT,IMT,C
Authorized Official - Phone:860-657-4471
Mailing Address - Street 1:34 JEROME AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2463
Mailing Address - Country:US
Mailing Address - Phone:860-519-1916
Mailing Address - Fax:860-986-6756
Practice Address - Street 1:34 JEROME AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:860-519-1916
Practice Address - Fax:860-986-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty