Healthcare Provider Details

I. General information

NPI: 1124934534
Provider Name (Legal Business Name): ALFRED MACNEILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 BERLIN TPKE
NEWINGTON CT
06111-3206
US

IV. Provider business mailing address

2307 BERLIN TPKE
NEWINGTON CT
06111-3206
US

V. Phone/Fax

Practice location:
  • Phone: 860-687-9700
  • Fax: 860-422-4632
Mailing address:
  • Phone: 860-687-9700
  • Fax: 860-422-4632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15643
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: