Provider Demographics
NPI:1700235157
Name:SPU THERAPY, LLC
Entity Type:Organization
Organization Name:SPU THERAPY, LLC
Other - Org Name:SPU THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR SPU THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:203-810-4811
Mailing Address - Street 1:37 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4405
Mailing Address - Country:US
Mailing Address - Phone:203-810-4811
Mailing Address - Fax:203-831-0418
Practice Address - Street 1:37 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4405
Practice Address - Country:US
Practice Address - Phone:203-810-4811
Practice Address - Fax:203-831-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1700235157Medicaid