# CENTER FOR PHYSICAL THERAPY & SPORTS REHAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538250642
- **Authorized official:** GERDT PROPFE JR. PT (CLINICAL DIRECTOR)
- **Authorized official phone:** (860) 446-8254

## Contact information

- **Practice address:** 495 GOLD STAR HWY, SUITE 112, GROTON, CT 06340-6803
- **Practice address phone:** (860) 446-8254
- **Practice address fax:** (860) 446-8293
- **Mailing address:** 495 GOLD STAR HWY, SUITE 112, GROTON, CT 06340-6803
- **Mailing address phone:** (860) 446-8254
- **Mailing address fax:** (860) 446-8293

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 1847 | CT | Yes |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 080001847CT01 | ANTHEM BLUE CROSS | CT |
| 01 | — | 0V1692 | HEALTH NET | CT |