Provider Demographics
NPI:1790084390
Name:CARLSON THERAPY NETWORK
Entity Type:Organization
Organization Name:CARLSON THERAPY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-739-0765
Mailing Address - Street 1:105 NEWTOWN RD # A
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4194
Mailing Address - Country:US
Mailing Address - Phone:203-739-0765
Mailing Address - Fax:203-739-0792
Practice Address - Street 1:105 NEWTOWN RD # A
Practice Address - Street 2:SUITE 5
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4194
Practice Address - Country:US
Practice Address - Phone:203-739-0765
Practice Address - Fax:203-739-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061162251H1200X
CT000144225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1216330002Medicare NSC