Provider Demographics
NPI:1730113051
Name:PHYSICAL THERAPY PLUS LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PLUS LLC
Other - Org Name:ENFIELD PHYSICAL THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ROSEMARIE
Authorized Official - Last Name:QUIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:860-265-2571
Mailing Address - Street 1:145 HAZARD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4521
Mailing Address - Country:US
Mailing Address - Phone:860-265-2571
Mailing Address - Fax:
Practice Address - Street 1:145 HAZARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4521
Practice Address - Country:US
Practice Address - Phone:860-265-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CT005596261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001216Medicare ID - Type UnspecifiedPROVIDER NUMBER