Organization
ECLECTIC PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LEE IANNUCCI PT (PHYSICAL THERAPIST, OWNER)
(203) 913-6978
Entity
Organization
Contact information
Practice address
2889 FAIRFIELD AVE, BRIDGEPORT, CT 06605-3211
(203) 913-6978
Mailing address
46 DRIFTWOOD LN, TRUMBULL, CT 06611-1861
(203) 913-6978
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
005735
CT
Other
Enumeration date
03/21/2013
Last updated
05/16/2014
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