| 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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