Provider Demographics
NPI:1770952608
Name:PROLETE PHYSICAL THERAPY & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:PROLETE PHYSICAL THERAPY & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIGBIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:203-693-3754
Mailing Address - Street 1:247 BROAD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3273
Mailing Address - Country:US
Mailing Address - Phone:203-693-3754
Mailing Address - Fax:203-283-3908
Practice Address - Street 1:247 BROAD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3273
Practice Address - Country:US
Practice Address - Phone:203-693-3754
Practice Address - Fax:203-283-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty