Provider Demographics
NPI:1851410294
Name:CENTER FOR PHYSICAL THERAPY AND WELLNESS, PC
Entity Type:Organization
Organization Name:CENTER FOR PHYSICAL THERAPY AND WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-242-8427
Mailing Address - Street 1:693 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2489
Mailing Address - Country:US
Mailing Address - Phone:860-242-8427
Mailing Address - Fax:860-242-4147
Practice Address - Street 1:693 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2489
Practice Address - Country:US
Practice Address - Phone:860-242-8427
Practice Address - Fax:860-242-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-11-04
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
CTC03443Medicare ID - Type Unspecified