Provider Demographics
NPI:1689905739
Name:PHYSIO-PLUS,LLC
Entity Type:Organization
Organization Name:PHYSIO-PLUS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:SODERLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-259-0200
Mailing Address - Street 1:1465 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5528
Mailing Address - Country:US
Mailing Address - Phone:203-259-0200
Mailing Address - Fax:203-663-8226
Practice Address - Street 1:1465 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5528
Practice Address - Country:US
Practice Address - Phone:203-259-0200
Practice Address - Fax:203-663-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty