Provider Demographics
NPI:1528191426
Name:AMITY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:AMITY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:203-389-4593
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE #801
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2285
Mailing Address - Country:US
Mailing Address - Phone:203-389-4593
Mailing Address - Fax:203-389-4609
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE #801
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-389-4593
Practice Address - Fax:203-389-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT006646225100000X
CTCT008058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT20910OtherORTHONET
CT080006646CT07OtherBCBS
CT20910OtherORTHONET