1023011681 NPI number — SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC

Table of content: (NPI 1023011681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023011681 NPI number — SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC
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:
SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC
Provider Other Organization Name Type Code:
3
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:
1023011681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 CROMWELL AVE
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-1851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-721-9801
Provider Business Mailing Address Fax Number:
860-721-8475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 CROMWELL AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
ROCKY HILL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06067-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-721-9801
Provider Business Practice Location Address Fax Number:
860-721-8475
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
MEMBER DIRECTOR OF PT
Authorized Official Telephone Number:
860-721-9801

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251G0304X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1023011681 . This is a "MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 119457 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C009365 . This is a "CHAMPUS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV1296 . This is a "HEATHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36401 . This is a "ORTHONET/CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CONN605700112 . This is a "PRIVATEHEALTHCARESYS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CT154333 . This is a "PREFERREDHEALTHNETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 015353 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 321802 . This is a "VALUEOPTIONS, INC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ANC1648 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7647500001 . This is a "CIGNA GROUP#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C02564 . This is a "MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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