Provider Demographics
NPI:1245088848
Name:FORTIFY WELLNESS AND PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FORTIFY WELLNESS AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSSEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:860-245-8914
Mailing Address - Street 1:3 TURKEY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9564
Mailing Address - Country:US
Mailing Address - Phone:860-245-8914
Mailing Address - Fax:
Practice Address - Street 1:3 TURKEY HILLS RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9564
Practice Address - Country:US
Practice Address - Phone:860-245-8914
Practice Address - Fax:860-957-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty