Provider Demographics
NPI:1609004340
Name:YOGABILITATION
Entity Type:Organization
Organization Name:YOGABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARENHOLTZT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:203-292-6365
Mailing Address - Street 1:325 REEF RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6537
Mailing Address - Country:US
Mailing Address - Phone:203-292-6365
Mailing Address - Fax:203-292-6366
Practice Address - Street 1:325 REEF RD
Practice Address - Street 2:SUITE 209
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6537
Practice Address - Country:US
Practice Address - Phone:203-292-6365
Practice Address - Fax:203-292-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003703225100000X
CT00579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty