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NPI Code Detail

MEDICARE: THOMASTON PHYSICAL THERAPY, LLC

MEDICARE: THOMASTON PHYSICAL THERAPY, LLC
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 Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00281232OTHERCTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13784149OTHERCTAETNA
26434282OTHERCTCIGNA
3080006109CT06OTHERCTANTHEM BC/BS
41828889OTHERCTUNITED HEALTHCARE
6080006109CT06OTHERCTANTHEM BLUECARE FAMILY
72V8292OTHERCTHEALTHNET

General Provider Information

NPI Number : 1689865792
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMASTON PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 258 S MAIN ST
Second Line :
City : THOMASTON
State : CT
Zip : 06787-1815
Country : US
Telephone Number : 860-283-2316
Fax Number : 860-283-6079
Provider Business Practice Location Address
First Line : 258 S MAIN ST
Second Line :
City : THOMASTON
State : CT
Zip : 06787-1815
Country : US
Telephone Number : 860-283-2316
Fax Number : 860-283-6079
Authorized Official
Title or Position : PHYSICAL THERAPIST/DIRECTOR
Name : MR. DALE L SWEET JR.
Credential : P.T.
Telephone Number : 860-283-2316
Provider Enumeration Date : 08/05/2007
Last Update Date : 08/05/2007

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1356579288 — MRS. KAREN ANN RECKMEYER LCSW
Practice Location Address:
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06787-1815
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Practice Fax: 860-283-6079

Directions to “THOMASTON PHYSICAL THERAPY, LLC ” Practice Location

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