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Organization
CENTER FOR PHYSICAL THERAPY & SPORTS REHAB
Active
Organization
CENTER FOR PHYSICAL THERAPY & SPORTS REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERDT PROPFE JR. PT (CLINICAL DIRECTOR)
(860) 446-8254
Entity
Organization
Contact information
Practice address
495 GOLD STAR HWY, SUITE 112, GROTON, CT 06340-6803
(860) 446-8254
(860) 446-8293
Mailing address
495 GOLD STAR HWY, SUITE 112, GROTON, CT 06340-6803
(860) 446-8254
(860) 446-8293
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1847
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080001847CT01
ANTHEM BLUE CROSS
CT
01
—
0V1692
HEALTH NET
CT
Enumeration date
09/27/2006
Last updated
08/22/2020
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