MEDICARE: MR. DALE L SWEET JR. PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6109	OTHER	CT	LICENSE
3	ANTHEM BC/BS	OTHER	CT	PROVIDER ID NUMBER

General Provider Information

NPI Number	:	1194705780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE L SWEET JR. PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	10 MARINE ST
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1470
Country	:	US
Telephone Number	:	860-283-2316
Fax Number	:	860-283-6079

Provider Business Practice Location Address
First Line	:	10 MARINE ST
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1470
Country	:	US
Telephone Number	:	860-283-2316
Fax Number	:	860-283-6079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	11/03/2023

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Directions to “ MR. DALE L SWEET JR. PHYSICAL THERAPIST” Practice Location

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