Provider Demographics
NPI:1205918653
Name:GREY PHYSICAL THERAPY & SPORTS MEDICINE CENTER OF ENFIELD, PC
Entity type:Organization
Organization Name:GREY PHYSICAL THERAPY & SPORTS MEDICINE CENTER OF ENFIELD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LENEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-741-2541
Mailing Address - Street 1:101 PHOENIX AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4471
Mailing Address - Country:US
Mailing Address - Phone:860-741-2541
Mailing Address - Fax:860-745-5264
Practice Address - Street 1:101 PHOENIX AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4471
Practice Address - Country:US
Practice Address - Phone:860-741-2541
Practice Address - Fax:860-745-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER