Provider Demographics
NPI:1306855309
Name:MAILHOT, CARL REMI (PT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:REMI
Last Name:MAILHOT
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 1:2B LEE RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351-3042
Mailing Address - Country:US
Mailing Address - Phone:860-376-2564
Mailing Address - Fax:860-373-4812
Practice Address - Street 1:165 HARTFORD PIKE
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-0425
Practice Address - Country:US
Practice Address - Phone:860-779-0150
Practice Address - Fax:860-774-2371
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080002387CT01OtherBCBS
CT004050266Medicaid
CT080002387CT01OtherBCBS