Provider Demographics
NPI:1497023949
Name:CONNECTICUT ORTHOPEDIC REHABILITATON ASSOCIATES LLC
Entity Type:Organization
Organization Name:CONNECTICUT ORTHOPEDIC REHABILITATON ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-525-2672
Mailing Address - Street 1:100 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2928
Mailing Address - Country:US
Mailing Address - Phone:860-525-2672
Mailing Address - Fax:860-727-0897
Practice Address - Street 1:136 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1315
Practice Address - Country:US
Practice Address - Phone:860-826-4763
Practice Address - Fax:860-826-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty