Provider Demographics
NPI:1841381969
Name:VALLEY PHYSICAL THERAPY & SPORTS MEDICINE SERVICES, P.C.
Entity Type:Organization
Organization Name:VALLEY PHYSICAL THERAPY & SPORTS MEDICINE SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-395-7659
Mailing Address - Street 1:14 JONES HOLLOW RD STE 7
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1448
Mailing Address - Country:US
Mailing Address - Phone:860-295-8188
Mailing Address - Fax:860-295-8976
Practice Address - Street 1:14 JONES HOLLOW RD STE 7
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1448
Practice Address - Country:US
Practice Address - Phone:860-295-8188
Practice Address - Fax:860-295-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004082525Medicaid
C02824Medicare ID - Type Unspecified