Organization
BLACK ROCK PHYSICAL THERAPY
Active
Other names
TLCPT
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TARA LYNN COLLINS P.T., IMT.C., CSCS (PHYSICAL THERAPIST/OWNER)
(203) 345-1720
Entity
Organization
Contact information
Practice address
2889 FAIRFIELD AVE, BRIDGEPORT, CT 06605-3211
(203) 335-1987
(203) 549-0725
Mailing address
2889 FAIRFIELD AVE, BRIDGEPORT, CT 06605-3211
(203) 335-1987
(203) 549-0725
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
004078
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D100000150
MEDICARE PTAN
CT
Enumeration date
01/30/2009
Last updated
05/03/2018
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