Provider Demographics
NPI:1609970201
Name:PHYSICAL THERAPY CENTER OF MADISON
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF MADISON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:REG PHYS THERAPIST
Authorized Official - Phone:203-245-9293
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443
Mailing Address - Country:US
Mailing Address - Phone:203-245-9293
Mailing Address - Fax:203-245-2522
Practice Address - Street 1:168 BOSTON POST RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2163
Practice Address - Country:US
Practice Address - Phone:203-245-9293
Practice Address - Fax:203-245-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6400348OtherUNITED HEALTHCARE
P819154OtherOXFORD
0036801OtherORTHONET
06-147926OtherHMC PPO
CT08-0004132CT07OtherANTHEM B/C B/S
5420450OtherAETNA
650012292OtherRAILROAD MEDICARE
2V8207OtherHEALTHNET
36801OtherCIGNA
650012292OtherRAILROAD MEDICARE
2V8207OtherHEALTHNET