Healthcare Provider Details

I. General information

NPI: 1023011681
Provider Name (Legal Business Name): SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 CROMWELL AVE STE 103
ROCKY HILL CT
06067-1851
US

IV. Provider business mailing address

506 CROMWELL AVE STE 103
ROCKY HILL CT
06067-1851
US

V. Phone/Fax

Practice location:
  • Phone: 860-721-9801
  • Fax: 860-721-8475
Mailing address:
  • Phone: 860-721-9801
  • Fax: 860-721-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS MICHAEL SWEENEY
Title or Position: MEMBER DIRECTOR OF PT
Credential: RPT
Phone: 860-721-9801