Provider Demographics
NPI:1356471049
Name:TODT, ANTHONY (MSPT CSCS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:TODT
Suffix:
Gender:M
Credentials:MSPT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARK AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1128
Mailing Address - Country:US
Mailing Address - Phone:860-917-6536
Mailing Address - Fax:860-267-6296
Practice Address - Street 1:7 PARK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1128
Practice Address - Country:US
Practice Address - Phone:860-917-6536
Practice Address - Fax:860-267-6296
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT35501OtherCIGNA
CT2V8297OtherHEALTHNET
CT080001245CT03OtherBLUE CROSS BLUE SHIELD
CT567709OtherAETNA