Provider Demographics
NPI:1629840798
Name:CONNECTIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CONNECTIVE PHYSICAL THERAPY LLC
Other - Org Name:CONNECTIVE PT NEURO PELVIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-349-3679
Mailing Address - Street 1:100 LEDGEWOOD CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5957
Mailing Address - Country:US
Mailing Address - Phone:802-349-3679
Mailing Address - Fax:
Practice Address - Street 1:1 KENNEDY DR STE U7
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7166
Practice Address - Country:US
Practice Address - Phone:802-349-3679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy