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NPI Code Detail

MEDICARE: MR. ANTHONY PEBURN PT

MEDICARE: MR. ANTHONY PEBURN PT
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
1225100000XPhysical Therapist006375CT

General Provider Information

NPI Number : 1265473177
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY PEBURN PT
Provider Business Mailing Address
First Line : 31 OLD ROUTE 7
Second Line :
City : BROOKFIELD
State : CT
Zip : 06804-1714
Country : US
Telephone Number : 203-740-0020
Fax Number : 203-775-0238
Provider Business Practice Location Address
First Line : 10B ELIZABETH ST
Second Line :
City : BETHEL
State : CT
Zip : 06801-2100
Country : US
Telephone Number : 203-778-0720
Fax Number : 203-778-6187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 07/08/2007

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Directions to “ MR. ANTHONY PEBURN PT” Practice Location

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