MEDICARE: SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251G0304X	Geriatric Physical Therapist
2	2251N0400X	Neurology Physical Therapist
3	2251S0007X	Sports Physical Therapist
4	2251X0800X	Orthopedic Physical Therapist
5	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023011681	OTHER	CT	MEDICARE
12	C02564	OTHER	CT	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	119457	OTHER	CT	AETNA
3	C009365	OTHER	CT	CHAMPUS
4	OV1296	OTHER	CT	HEATHNET
5	36401	OTHER	CT	ORTHONET/CIGNA
6	CONN605700112	OTHER	CT	PRIVATEHEALTHCARESYS
7	CT154333	OTHER	CT	PREFERREDHEALTHNETWORK
8	015353	OTHER	CT	CONNECTICARE
9	321802	OTHER	CT	VALUEOPTIONS, INC
10	ANC1648	OTHER	CT	OXFORD HEALTH PLANS
11	7647500001	OTHER	CT	CIGNA GROUP#

General Provider Information

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

Provider Business Mailing Address
First Line	:	506 CROMWELL AVE
Second Line	:	STE 103
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1851
Country	:	US
Telephone Number	:	860-721-9801
Fax Number	:	860-721-8475

Provider Business Practice Location Address
First Line	:	506 CROMWELL AVE
Second Line	:	STE 103
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1851
Country	:	US
Telephone Number	:	860-721-9801
Fax Number	:	860-721-8475

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	06/20/2018

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Practice Location Address:

506 CROMWELL AVE , SUITE 103
ROCKY HILL, CT
06067-1851

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506 CROMWELL AVE
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