Provider Demographics
NPI:1073585386
Name:BIANCHINI, JOHN D (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:BIANCHINI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7205
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-0205
Mailing Address - Country:US
Mailing Address - Phone:203-758-5040
Mailing Address - Fax:203-758-5042
Practice Address - Street 1:44 WATERBURY RD
Practice Address - Street 2:STE. 1C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1242
Practice Address - Country:US
Practice Address - Phone:203-758-5040
Practice Address - Fax:203-758-5042
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58312251X0800X
CT007742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007742CT01OtherANTHEM BC BS
CT080007742CT02OtherANTHEM BC BS
CT080007742CT06OtherANTHEM BCBS
CT080007742CT01OtherANTHEM BC BS
CT650001530Medicare PIN