Provider Demographics
NPI:1811767395
Name:PATH 2 SELF PERFORMANCE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PATH 2 SELF PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BECKWITH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:860-908-6139
Mailing Address - Street 1:1663 ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1500
Mailing Address - Country:US
Mailing Address - Phone:860-908-6139
Mailing Address - Fax:
Practice Address - Street 1:1663 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1500
Practice Address - Country:US
Practice Address - Phone:860-908-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy