Provider Demographics
NPI:1053618728
Name:ESSENTIAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ESSENTIAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLOGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:860-966-2152
Mailing Address - Street 1:7 ANJA DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1546
Mailing Address - Country:US
Mailing Address - Phone:860-966-2152
Mailing Address - Fax:860-735-6545
Practice Address - Street 1:995 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1812
Practice Address - Country:US
Practice Address - Phone:860-966-2152
Practice Address - Fax:860-735-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty