# CENTRAL CT SPORTS MEDICINE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Central CT Physical Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104982826
- **Authorized official:** MRS. CATHY A. FELLOWS (BUSINESS MANAGER)
- **Authorized official phone:** (860) 829-1300

## Contact information

- **Practice address:** 15 MASSIRIO DR, BERLIN, CT 06037-2322
- **Practice address phone:** (860) 829-1300
- **Practice address fax:** (860) 829-1388
- **Mailing address:** 15 MASSIRIO DR, BERLIN, CT 06037-2322
- **Mailing address phone:** (860) 829-1300
- **Mailing address fax:** (860) 829-1388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 02/05/2008