Provider Demographics
NPI:1922171537
Name:PHYSICAL THERAPY AND MASSAGE OF CT, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND MASSAGE OF CT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PECORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-582-8024
Mailing Address - Street 1:1001 FARMINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3990
Mailing Address - Country:US
Mailing Address - Phone:860-582-8024
Mailing Address - Fax:860-585-0609
Practice Address - Street 1:1001 FARMINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3990
Practice Address - Country:US
Practice Address - Phone:860-582-8024
Practice Address - Fax:860-585-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy