Provider Demographics
NPI:1235256066
Name:BIANCO, THOMAS PAUL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PAUL
Last Name:BIANCO
Suffix:
Gender:M
Credentials:MSPT
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 86
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0086
Mailing Address - Country:US
Mailing Address - Phone:413-221-4956
Mailing Address - Fax:413-596-2311
Practice Address - Street 1:275 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3562
Practice Address - Country:US
Practice Address - Phone:413-221-4956
Practice Address - Fax:413-596-2311
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 8237-PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA699853OtherCONNECTICARE
MAY66995OtherBCBS- INDIVIDUAL NUMBER
MAY61173OtherBCBS-GROUP NUMBER
MA0360317Medicaid
Y68793Medicare ID - Type Unspecified