Provider Demographics
NPI:1609413491
Name:BEYOND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BEYOND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER/OWNER/RPT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:860-302-3687
Mailing Address - Street 1:120 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5672
Mailing Address - Country:US
Mailing Address - Phone:860-302-3687
Mailing Address - Fax:860-582-9200
Practice Address - Street 1:120 STEELE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5672
Practice Address - Country:US
Practice Address - Phone:860-302-3687
Practice Address - Fax:860-582-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy