Provider Demographics
NPI:1053593913
Name:RIDGEFIELD PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RIDGEFIELD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:203-438-1898
Mailing Address - Street 1:63 COPPS HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4112
Mailing Address - Country:US
Mailing Address - Phone:203-438-1898
Mailing Address - Fax:203-438-1964
Practice Address - Street 1:63 COPPS HILL ROAD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4112
Practice Address - Country:US
Practice Address - Phone:203-438-1898
Practice Address - Fax:203-438-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03081Medicare PIN