Provider Demographics
NPI:1346783768
Name:LOONEY, SCOTT (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:LOONEY
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BRIDGE ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-3107
Mailing Address - Country:US
Mailing Address - Phone:860-254-5982
Mailing Address - Fax:860-254-5985
Practice Address - Street 1:68 BRIDGE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-3107
Practice Address - Country:US
Practice Address - Phone:860-254-5982
Practice Address - Fax:860-254-5985
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist