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General NPI Number Information
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NPI Number | 1174704159
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Entity Type | Organization
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Legal Business Name | POST ROAD PHYSICAL THERAPY & SPORTS MEDICINE CLINIC, LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 246 E MAIN ST SUITE 5
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City | CLINTON
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State | CT
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Zip | 06413-2245
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Country | US
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Telephone | 860-664-0366
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Fax |
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Provider Business Mailing Address
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Address Line | 246 E MAIN ST SUITE 5
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City | CLINTON
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State | CT
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Zip | 06413-2245
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Country | US
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Telephone | 860-664-0366
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. THOMAS PARE
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Credential | P.T.,A.T.,C.
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Telephone | 860-664-0366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3248
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License Number State | CT
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