Provider Demographics
NPI:1972686533
Name:PEDIAFLEX THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:PEDIAFLEX THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LUGINBUHL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-306-6423
Mailing Address - Street 1:84 SNIPSIC LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3519
Mailing Address - Country:US
Mailing Address - Phone:860-306-6423
Mailing Address - Fax:860-875-6423
Practice Address - Street 1:465 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2134
Practice Address - Country:US
Practice Address - Phone:860-306-6423
Practice Address - Fax:860-875-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty