Organization
MASONICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ROY (PHYSICAL THERAPY ASSISTANT)
(203) 679-6273
Entity
Organization
Contact information
Practice address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-6273
(203) 679-6142
Mailing address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
10/03/2008
Last updated
10/03/2008
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