Provider Demographics
NPI:1700216967
Name:PERFORMANCE PHYSICAL THERAPY OF HAMDEN LLC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY OF HAMDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-422-0679
Mailing Address - Street 1:333 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4701
Mailing Address - Country:US
Mailing Address - Phone:203-422-0679
Mailing Address - Fax:203-422-0931
Practice Address - Street 1:333 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4701
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:203-422-0931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFORMANCE HEALTH CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-25
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty