Provider Demographics
NPI:1447435052
Name:MOUNTAIN PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:MOUNTAIN PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-674-1569
Mailing Address - Street 1:31 ENSIGN DR
Mailing Address - Street 2:A
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3773
Mailing Address - Country:US
Mailing Address - Phone:860-674-1569
Mailing Address - Fax:
Practice Address - Street 1:31 ENSIGN DR
Practice Address - Street 2:A
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3773
Practice Address - Country:US
Practice Address - Phone:860-674-1569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy