Provider Demographics
NPI:1598822603
Name:SPORTSMEDICINE PARTNERS, ORTHOPEDICS & REHABILITATION THERAPY, P.C.
Entity Type:Organization
Organization Name:SPORTSMEDICINE PARTNERS, ORTHOPEDICS & REHABILITATION THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-644-5900
Mailing Address - Street 1:2800 TAMARACK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074
Mailing Address - Country:US
Mailing Address - Phone:860-644-5900
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:2800 TAMARACK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074
Practice Address - Country:US
Practice Address - Phone:860-644-5900
Practice Address - Fax:860-282-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty