Provider Demographics
NPI:1629782180
Name:GV MEDICAL PRACTICE, LLC
Entity Type:Organization
Organization Name:GV MEDICAL PRACTICE, LLC
Other - Org Name:CONNECTICUT REHAB AND MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VALETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-351-5528
Mailing Address - Street 1:17 FARMINGTON AVE BLDG B2ND
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1700
Mailing Address - Country:US
Mailing Address - Phone:860-351-5528
Mailing Address - Fax:888-417-4305
Practice Address - Street 1:17 FARMINGTON AVE BLDG B2ND
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1700
Practice Address - Country:US
Practice Address - Phone:203-536-6274
Practice Address - Fax:888-417-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty