Provider Demographics
NPI:1790813947
Name:ACTIVE ORTHOPEDIC THERAPY PC
Entity Type:Organization
Organization Name:ACTIVE ORTHOPEDIC THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REGNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-729-2344
Mailing Address - Street 1:1183 NEW HAVEN RD
Mailing Address - Street 2:STE206
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-5033
Mailing Address - Country:US
Mailing Address - Phone:203-729-2344
Mailing Address - Fax:203-729-2355
Practice Address - Street 1:1183 NEW HAVEN RD
Practice Address - Street 2:STE206
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-5033
Practice Address - Country:US
Practice Address - Phone:203-729-2344
Practice Address - Fax:203-729-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID