1619351608 NPI number — AMITY PHYSICAL THERAPY OF HAMDEN

Table of content: (NPI 1619351608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619351608 NPI number — AMITY PHYSICAL THERAPY OF HAMDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMITY PHYSICAL THERAPY OF HAMDEN
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:
6
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:
1619351608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2285 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-691-6248
Provider Business Mailing Address Fax Number:
203-691-9239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BRADLEY RD STE 801
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06525-2296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-389-4593
Provider Business Practice Location Address Fax Number:
203-389-4609
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DOW
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
203-389-4593

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  00646 , 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)





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