| Organization Name: | CROSSROADS ORTHOPEDIC SUBSPECIALISTS, LLC DBA CROSSROADS PHYSICAL THER |
| NPI Number: | 1023028834 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREG COOPER (MANAGING PARTNER) |
| Mailing Address: | 196 Parkway S Suite 202 Waterford |
| State: | CT US |
| Postal Code: | 063851234 |
| Phone Number: | 8604472193 |
| Fax Number: | |
| NPI Enumeration Date: | 08/08/2006 |
| NPI Last Update Date: | 12/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |