Healthcare Provider Details

I. General information

NPI: 1215740907
Provider Name (Legal Business Name): ADAPT PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17B COMMERCE ST
CLINTON CT
06413-2094
US

IV. Provider business mailing address

17B COMMERCE ST
CLINTON CT
06413-2094
US

V. Phone/Fax

Practice location:
  • Phone: 570-877-7209
  • Fax:
Mailing address:
  • Phone: 570-877-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONOVAN JORDAN ASHTON
Title or Position: PHYSICAL THERAPIST/ATHLETIC TRAINER
Credential: PT, DPT, LAT, ATC
Phone: 570-877-7209