Provider Demographics
NPI:1215247481
Name:SPECTRUM PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:SPECTRUM PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:11 FREEDOM WAY
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1041
Mailing Address - Country:US
Mailing Address - Phone:860-691-8960
Mailing Address - Fax:860-691-8969
Practice Address - Street 1:11 FREEDOM WAY
Practice Address - Street 2:SUITE B-2
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1041
Practice Address - Country:US
Practice Address - Phone:860-691-8960
Practice Address - Fax:860-691-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6479200001Medicare NSC
CTD100040779Medicare PIN