Provider Demographics
NPI:1790314904
Name:RIVER ROCK PHYSICAL THERAPY AND BALANCE CENTER LLC
Entity Type:Organization
Organization Name:RIVER ROCK PHYSICAL THERAPY AND BALANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ST LOUIS
Authorized Official - Last Name:RISIGO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-268-3226
Mailing Address - Street 1:744 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2307
Mailing Address - Country:US
Mailing Address - Phone:860-365-5514
Mailing Address - Fax:860-499-5356
Practice Address - Street 1:744 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2307
Practice Address - Country:US
Practice Address - Phone:860-268-3226
Practice Address - Fax:860-499-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty