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General NPI Number Information
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NPI Number | 1366523029
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PHYSICAL THERAPY & SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 340 BROAD ST 1ST FLOOR
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City | WINDSOR
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State | CT
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Zip | 06095-3030
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Country | US
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Telephone | 860-683-1007
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Fax | 860-683-1772
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Provider Business Mailing Address
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Address Line | 340 BROAD ST 1ST FLOOR
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City | WINDSOR
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State | CT
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Zip | 06095-3030
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Country | US
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Telephone | 860-683-1007
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Fax | 860-683-1772
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Authorized Official
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Title or Position | PARTNER
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Name | MARK A SULLIVAN
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Credential | RPT
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Telephone | 860-683-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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