Provider Demographics
NPI:1124054598
Name:OETTING STEBBINS PHYSICAL THERAPY
Entity type:Organization
Organization Name:OETTING STEBBINS PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-302-3570
Mailing Address - Street 1:25 VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:203-302-3570
Mailing Address - Fax:203-302-3575
Practice Address - Street 1:25 VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:203-302-3570
Practice Address - Fax:203-302-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CT003943CT225100000X
CT006506CT225100000X
CT002631CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02029Medicare ID - Type UnspecifiedMEDICARE GROUP #
CTANC866Medicare ID - Type UnspecifiedOXFORD ORTHONET #