Provider Demographics
NPI:1609025394
Name:CENTERED HEALTH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CENTERED HEALTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:860-648-0659
Mailing Address - Street 1:1477 PARK ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2235
Mailing Address - Country:US
Mailing Address - Phone:860-648-0659
Mailing Address - Fax:
Practice Address - Street 1:1477 PARK ST
Practice Address - Street 2:SUITE 14
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2235
Practice Address - Country:US
Practice Address - Phone:860-648-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07875208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty