Provider Demographics
NPI:1871896316
Name:SELECT PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SELECT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOPINO
Authorized Official - Suffix:II
Authorized Official - Credentials:PHYSICAL /THERAPIST
Authorized Official - Phone:203-910-4349
Mailing Address - Street 1:16 BURGESS RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:CT
Mailing Address - Zip Code:06763-1022
Mailing Address - Country:US
Mailing Address - Phone:203-910-4349
Mailing Address - Fax:
Practice Address - Street 1:16 BURGESS RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:CT
Practice Address - Zip Code:06763-1022
Practice Address - Country:US
Practice Address - Phone:203-910-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1346445186OtherNPI