Provider Demographics
NPI:1801962444
Name:RIFKIN PHYSICAL THERAPY & LYMPHEDEMA CENTER LLC
Entity type:Organization
Organization Name:RIFKIN PHYSICAL THERAPY & LYMPHEDEMA CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT CLT LANA
Authorized Official - Phone:203-758-6569
Mailing Address - Street 1:21 HOLLEY LANE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712
Mailing Address - Country:US
Mailing Address - Phone:203-758-6569
Mailing Address - Fax:203-758-0443
Practice Address - Street 1:93 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712
Practice Address - Country:US
Practice Address - Phone:203-758-6569
Practice Address - Fax:203-758-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5171OtherRAILROAD MEDICARE
695102OtherUNITED HEALTHCARE
695102OtherUNITED HEALTHCARE