=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356471049
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY TODT MSPT CSCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 PARK AVE SUITE 4
-----------------------------------------------------
City | COLCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06415-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-917-6536
-----------------------------------------------------
Fax | 860-267-6296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 PARK AVE SUITE 4
-----------------------------------------------------
City | COLCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06415-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-917-6536
-----------------------------------------------------
Fax | 860-267-6296
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 6462
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------