Provider Demographics
NPI:1427599414
Name:MAIN STREET PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MAIN STREET PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-693-6226
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-0466
Mailing Address - Country:US
Mailing Address - Phone:860-482-4888
Mailing Address - Fax:860-482-8444
Practice Address - Street 1:36 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5303
Practice Address - Country:US
Practice Address - Phone:860-482-4888
Practice Address - Fax:860-482-8444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANTON PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty