Provider Demographics
NPI:1679715239
Name:BISHOPS CORNER PHYSICAL THERAPY
Entity type:Organization
Organization Name:BISHOPS CORNER PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:917-922-8990
Mailing Address - Street 1:576 MOUNTAIN RD APT C
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1826
Mailing Address - Country:US
Mailing Address - Phone:917-922-8990
Mailing Address - Fax:
Practice Address - Street 1:576 MOUNTAIN RD APT C
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1826
Practice Address - Country:US
Practice Address - Phone:917-922-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM0079682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076536Medicare PIN