Provider Demographics
NPI:1356884522
Name:UNIFIED THERAPY, LLC
Entity type:Organization
Organization Name:UNIFIED THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:VENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:860-644-2335
Mailing Address - Street 1:915 SULLIVAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2165
Mailing Address - Country:US
Mailing Address - Phone:860-644-2335
Mailing Address - Fax:888-974-2148
Practice Address - Street 1:869 SULLIVAN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2007
Practice Address - Country:US
Practice Address - Phone:860-644-2335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4793225XP0200X
CT002397235Z00000X, 235Z00000X
CT0071482251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty