Healthcare Provider Details

I. General information

NPI: 1770539959
Provider Name (Legal Business Name): ROBERT THOMPSON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SEYMOUR AVE SUITE 101
DERBY CT
06418-1343
US

IV. Provider business mailing address

627 HORSEBLOCK RD SUITE 7
FARMINGVILLE NY
11738-2137
US

V. Phone/Fax

Practice location:
  • Phone: 203-734-2600
  • Fax: 203-734-0700
Mailing address:
  • Phone: 631-451-3773
  • Fax: 631-451-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: