Provider Demographics
NPI:1023011681
Name:SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC
Other - Org Name:SUBURBAN PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER DIRECTOR OF PT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:860-721-9801
Mailing Address - Street 1:506 CROMWELL AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1851
Mailing Address - Country:US
Mailing Address - Phone:860-721-9801
Mailing Address - Fax:860-721-8475
Practice Address - Street 1:506 CROMWELL AVE
Practice Address - Street 2:STE 103
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1851
Practice Address - Country:US
Practice Address - Phone:860-721-9801
Practice Address - Fax:860-721-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1023011681OtherMEDICARE
CT119457OtherAETNA
CTC009365OtherCHAMPUS
CTOV1296OtherHEATHNET
CT36401OtherORTHONET/CIGNA
CTCONN605700112OtherPRIVATEHEALTHCARESYS
CTCT154333OtherPREFERREDHEALTHNETWORK
CT015353OtherCONNECTICARE
CT321802OtherVALUEOPTIONS, INC
CTANC1648OtherOXFORD HEALTH PLANS
CT7647500001OtherCIGNA GROUP#
CTC02564OtherMEDICARE
CT7647500001OtherCIGNA GROUP#
CT=========OtherPRIVATE HEALTHCARE SYSTEMS