Organization
CONNECTICUT SPORTS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY HOM DC (OWNER)
(203) 589-0226
Entity
Organization
Contact information
Practice address
129 CHURCH ST FL 1, NEW HAVEN, CT 06510-2026
(203) 200-0099
Mailing address
57 ORANGE ST, NEW HAVEN, CT 06510-3150
(203) 589-0226
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2028
CT
Other
Enumeration date
06/13/2018
Last updated
03/21/2025
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