Provider Demographics
NPI:1750342440
Name:TEAM REHAB PC
Entity type:Organization
Organization Name:TEAM REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-778-8326
Mailing Address - Street 1:22 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4129
Mailing Address - Country:US
Mailing Address - Phone:203-778-8326
Mailing Address - Fax:203-792-9170
Practice Address - Street 1:22 EAGLE RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4129
Practice Address - Country:US
Practice Address - Phone:203-778-8326
Practice Address - Fax:203-792-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59791Medicare UPIN
CTC O3253Medicare PIN