Provider Demographics
NPI:1730209271
Name:PHILIP PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PHILIP PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:203-216-0516
Mailing Address - Street 1:145 SZOST DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4041
Mailing Address - Country:US
Mailing Address - Phone:203-216-0516
Mailing Address - Fax:
Practice Address - Street 1:42 VITTI ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4823
Practice Address - Country:US
Practice Address - Phone:203-966-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy