Provider Demographics
NPI:1134524333
Name:NEW ENGLAND PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:NEW ENGLAND PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUOMALA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:203-909-1974
Mailing Address - Street 1:1003 WALLINGFORD RD
Mailing Address - Street 2:B
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2946
Mailing Address - Country:US
Mailing Address - Phone:203-909-1974
Mailing Address - Fax:
Practice Address - Street 1:1003 WALLINGFORD RD
Practice Address - Street 2:B
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2946
Practice Address - Country:US
Practice Address - Phone:203-909-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty