Provider Demographics
NPI:1417995549
Name:MICHAEL DALEY
Entity Type:Organization
Organization Name:MICHAEL DALEY
Other - Org Name:COMMUNITY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-621-7389
Mailing Address - Street 1:360 N MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-621-7389
Mailing Address - Fax:860-621-2586
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2503
Practice Address - Country:US
Practice Address - Phone:860-621-7389
Practice Address - Fax:860-621-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004252152Medicaid
CT104537400OtherDEPARTMENT OF LABOR
CT2V83221OtherHEALTHNET
CT0121901OtherORTHONET
CTCI7695OtherMEDICARE RAILROAD
CTCI7695OtherMEDICARE RAILROAD