Healthcare Provider Details

I. General information

NPI: 1174704159
Provider Name (Legal Business Name): POST ROAD PHYSICAL THERAPY & SPORTS MEDICINE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E MAIN ST SUITE 5
CLINTON CT
06413-2245
US

IV. Provider business mailing address

246 E MAIN ST SUITE 5
CLINTON CT
06413-2245
US

V. Phone/Fax

Practice location:
  • Phone: 860-664-0366
  • Fax:
Mailing address:
  • Phone: 860-664-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3248
License Number StateCT

VIII. Authorized Official

Name: MR. THOMAS PARE
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.,A.T.,C.
Phone: 860-664-0366