Provider Demographics
NPI:1598938052
Name:GLASTONBURY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GLASTONBURY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-430-9780
Mailing Address - Street 1:701 HEBRON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2489
Mailing Address - Country:US
Mailing Address - Phone:860-430-9780
Mailing Address - Fax:860-430-9781
Practice Address - Street 1:701 HEBRON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2489
Practice Address - Country:US
Practice Address - Phone:860-430-9780
Practice Address - Fax:860-430-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007000225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty