# OMNI PHYSICAL & AQUATIC THERAPY CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Omni Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861537995
- **Authorized official:** TRISHA ANN MAHONEY-RANDALL (BILLING MANAGER)
- **Authorized official phone:** (203) 877-0112

## Contact information

- **Practice address:** 8 RESEARCH PKWY, WALLINGFORD, CT 06492-1929
- **Practice address phone:** (203) 294-1998
- **Practice address fax:** (203) 294-1189
- **Mailing address:** 8 RESEARCH PKWY, WALLINGFORD, CT 06492-1929
- **Mailing address phone:** (203) 294-1998
- **Mailing address fax:** (203) 294-1189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | CT | — |
| 111NR0400X | Rehabilitation Chiropractor | — | CT | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | — | — |
| 225100000X | Physical Therapist | — | CT | — |
| 2251G0304X | Geriatric Physical Therapist | — | CT | — |
| 2251X0800X | Orthopedic Physical Therapist | — | CT | — |
| 225X00000X | Occupational Therapist | — | CT | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 004173184 | BLUE CARE FAMILY PLAN | CT |
| 05 | — | 004173184 | — | CT |
| 05 | — | 004255271 | — | CT |
| 01 | — | 0V1691 | HEALTHNET | CT |
| 01 | — | 183158 | FIRST CHOICE | CT |
| 01 | — | 552470 | AETNA | CT |
| 01 | — | 6404254 | UNITED HEALTHCARE | CT |
| 01 | — | 712712 | CONNECTICARE | CT |
| 01 | — | A667399 | OXFORD | CT |