Provider Demographics
NPI:1083752109
Name:KENT PHYSICAL THERAPY, LLP
Entity Type:Organization
Organization Name:KENT PHYSICAL THERAPY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-927-4559
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0034
Mailing Address - Country:US
Mailing Address - Phone:860-927-4559
Mailing Address - Fax:860-927-3352
Practice Address - Street 1:64 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-0034
Practice Address - Country:US
Practice Address - Phone:860-927-4559
Practice Address - Fax:860-927-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7535921004OtherCIGNA PROVIDER
NYP2057224OtherOXFORD OUT OF NETWORK PRO
CTOV6316OtherHEALTH NET PROVIDER
CT0015901OtherORTHONET HEALTH NET PROVI
CT64-04275OtherUNITED HEALTH CARE PROVID
CT15901OtherCIGNA ORTHONET PROVIDER
CT2288136OtherAETNA PROVIDER
CT15901OtherCIGNA ORTHONET PROVIDER
CT=========OtherNORTHEAST DIRECT HEALTH
CT=========OtherPHCS PROVIDER
CT7535921004OtherCIGNA PROVIDER