| Eclectic Physical Therapy Llc | |
| 
					2889 Fairfield Ave Bridgeport CT 06605-3211  | |
| (203) 913-6978 | |
| Not Available | 
| Full Name | Eclectic Physical Therapy Llc | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 2889 Fairfield Ave, Bridgeport, Connecticut | 
| Authorized Official Name and Position | Jennifer Lee Iannucci (PHYSICAL THERAPIST, OWNER) | 
| Authorized Official Contact | 2039136978 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Eclectic Physical Therapy Llc 46 Driftwood Ln Trumbull CT 06611-1861 Ph: (203) 913-6978  | Eclectic Physical Therapy Llc 2889 Fairfield Ave Bridgeport CT 06605-3211 Ph: (203) 913-6978  | 
| NPI Number | 1730421397 | 
|---|---|
| Provider Enumeration Date | 03/21/2013 | 
| Last Update Date | 05/16/2014 | 
| Medicare PECOS PAC ID | 5991029126 | 
|---|---|
| Medicare Enrollment ID | O20150119000088 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1730421397 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | 005735 (Connecticut) | Primary | 
| Provider Name | Jennifer L Iannucci | 
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice | 
| Provider Identifiers | NPI Number: 1831128834 PECOS PAC ID: 9436473667 Enrollment ID: I20150216000124  | 
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