# MD PHYSICAL THERAPY ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WEST HAVEN MEDICAL GROUP, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1538498902
- **Legal business name:** WEST HAVEN MEDICAL GROUP, LLC
- **Authorized official:** DR. ANURUDDHA WALALIYADDA M.D. (MANAGING PARTNER)
- **Authorized official phone:** (203) 932-6481

## Contact information

- **Practice address:** 689 CAMPBELL AVE, WEST HAVEN, CT 06516-3711
- **Practice address phone:** (203) 932-6481
- **Practice address fax:** (203) 932-4051
- **Mailing address:** 689 CAMPBELL AVE, WEST HAVEN, CT 06516-3711
- **Mailing address phone:** (203) 932-6481
- **Mailing address fax:** (203) 932-4051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 9446592000 | CT | Yes |

## Other

- **Enumeration date:** 12/15/2009
- **Last updated:** 12/15/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1417955923 | WEST HAVEN MEDICAL GROUP, LLC, NPI \# | CT |