Provider Demographics
NPI:1336392950
Name:PERSONAL WELLNESS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PERSONAL WELLNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-809-7813
Mailing Address - Street 1:817 TOTOKET RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1458
Mailing Address - Country:US
Mailing Address - Phone:203-484-0601
Mailing Address - Fax:
Practice Address - Street 1:35 BOSTON ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2817
Practice Address - Country:US
Practice Address - Phone:203-809-7813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty