1649476730 NPI number — AFTERCARE PHYSICAL THERAPY SERVICES

Table of content: (NPI 1649476730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649476730 NPI number — AFTERCARE PHYSICAL THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFTERCARE PHYSICAL THERAPY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649476730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4154 MADISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-3563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-372-5718
Provider Business Mailing Address Fax Number:
203-372-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4154 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-372-5718
Provider Business Practice Location Address Fax Number:
203-372-0291
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORTATI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER, LLC
Authorized Official Telephone Number:
203-372-5718

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  CT5669 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0941807003 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: S57D01 . This is a "EMPIRE (ORTHONET)" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1944369 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080005669CT10 . This is a "ANTHEM BC-BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2022372 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V8089 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 10401 . This is a "CIGNA (ORTHONET)" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7482792 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 657588 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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