Provider Demographics
NPI:1851359186
Name:PHYSICAL THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:203-573-9806
Mailing Address - Street 1:417 HIGHLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3454
Mailing Address - Country:US
Mailing Address - Phone:203-573-9806
Mailing Address - Fax:203-573-9806
Practice Address - Street 1:417 HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3454
Practice Address - Country:US
Practice Address - Phone:203-573-9806
Practice Address - Fax:203-573-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0506722OtherUS HEALTHCARE
6404274OtherUNITED HEALTHCARE
ANC733OtherOXFORD
OV1720OtherHEALTH NET
080001428CT02OtherBCBS
OV1720OtherHEALTH NET