Provider Demographics
NPI:1558503953
Name:TEMPLE PT & LIFE SCIENCES
Entity Type:Organization
Organization Name:TEMPLE PT & LIFE SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-407-3508
Mailing Address - Street 1:230 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3224
Mailing Address - Country:US
Mailing Address - Phone:203-498-5980
Mailing Address - Fax:203-498-5999
Practice Address - Street 1:84 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3061
Practice Address - Country:US
Practice Address - Phone:203-483-2509
Practice Address - Fax:203-483-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac FacilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076512Medicare Oscar/Certification
CTC02525Medicare PIN