1083752109 NPI number — KENT PHYSICAL THERAPY, LLP

Table of content: (NPI 1083752109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083752109 NPI number — KENT PHYSICAL THERAPY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT PHYSICAL THERAPY, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083752109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06757-0034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-927-4559
Provider Business Mailing Address Fax Number:
860-927-3352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06757-0034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-927-4559
Provider Business Practice Location Address Fax Number:
860-927-3352
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEBOER
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
860-927-4559

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004720 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7535921004 . This is a "CIGNA PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2057224 . This is a "OXFORD OUT OF NETWORK PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OV6316 . This is a "HEALTH NET PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0015901 . This is a "ORTHONET HEALTH NET PROVI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04275 . This is a "UNITED HEALTH CARE PROVID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 15901 . This is a "CIGNA ORTHONET PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2288136 . This is a "AETNA PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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