Provider Demographics
NPI:1669070827
Name:HOMETOWN HEALTH, LLC
Entity type:Organization
Organization Name:HOMETOWN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:860-752-2733
Mailing Address - Street 1:54 HAZARD AVE # 161
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3845
Mailing Address - Country:US
Mailing Address - Phone:860-752-2733
Mailing Address - Fax:
Practice Address - Street 1:54 HAZARD AVE # 161
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3845
Practice Address - Country:US
Practice Address - Phone:860-752-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy