Provider Demographics
NPI:1598009177
Name:BODY FLEX PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BODY FLEX PHYSICAL THERAPY LLC
Other - Org Name:BODY FLEX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLONGHI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-759-2011
Mailing Address - Street 1:595 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1156
Mailing Address - Country:US
Mailing Address - Phone:860-759-2011
Mailing Address - Fax:860-342-4104
Practice Address - Street 1:28 KRISTEN DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1153
Practice Address - Country:US
Practice Address - Phone:860-759-2011
Practice Address - Fax:860-342-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002972225100000X, 2251G0304X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty