| Organization Name: | ESSENTIAL PHYSICAL THERAPY, LLC |
| NPI Number: | 1053618728 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHANIE A. BOLOGA (PRINCIPAL) |
| Mailing Address: | 995 Hopmeadow St Simsbury |
| State: | CT US |
| Postal Code: | 060701812 |
| Phone Number: | 8609662152 |
| Fax Number: | 8607356545 |
| NPI Enumeration Date: | 02/16/2011 |
| NPI Last Update Date: | 02/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251S0007X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Sports |
| Taxonomy Definition: | |