Provider Demographics
NPI:1770562720
Name:WOODBURY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WOODBURY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON BETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-263-0002
Mailing Address - Street 1:264 MAIN ST S
Mailing Address - Street 2:STE 200
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798
Mailing Address - Country:US
Mailing Address - Phone:203-263-0002
Mailing Address - Fax:203-263-0090
Practice Address - Street 1:264 MAIN ST S
Practice Address - Street 2:STE 200
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798
Practice Address - Country:US
Practice Address - Phone:203-263-0002
Practice Address - Fax:203-263-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001680208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty