Provider Demographics
NPI:1376661660
Name:TREPSICORE LLC
Entity type:Organization
Organization Name:TREPSICORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, PT
Authorized Official - Phone:860-918-1542
Mailing Address - Street 1:161 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3402
Mailing Address - Country:US
Mailing Address - Phone:860-652-8131
Mailing Address - Fax:860-812-2001
Practice Address - Street 1:161 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3402
Practice Address - Country:US
Practice Address - Phone:860-652-8131
Practice Address - Fax:860-812-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004526261QP2000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy