Organization
PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Active
Other names
PhysioCare Physical Therapy and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN H BRADFORD PT (OWNER/PHYSICAL THERAPIST)
(860) 608-2773
Entity
Organization
Contact information
Practice address
11 CENTRE ST, SUITE 6&7, SALEM, CT 06420-3844
(860) 608-2773
(860) 471-8388
Mailing address
11 CENTRE ST, SUITE 6&7, SALEM, CT 06420-3844
(860) 608-2773
(860) 471-8388
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006963
CT
225100000X
Physical Therapist
009704
CT
225X00000X
Occupational Therapist
004259
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004221868-02
—
CT
Enumeration date
06/21/2011
Last updated
10/02/2014
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