Provider Demographics
NPI:1427036805
Name:MCLAUGHLIN PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Entity Type:Organization
Organization Name:MCLAUGHLIN PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA PT
Authorized Official - Phone:860-621-5054
Mailing Address - Street 1:18 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-621-5054
Mailing Address - Fax:860-620-0270
Practice Address - Street 1:18 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-621-5054
Practice Address - Fax:860-620-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080002404CT03OtherANTHEM BLUE CROSS BLUE SH
509196OtherAETNA US HEALTHCARE
P451833OtherOXFORD HEALTH PLANS
OVO867OtherHEALTHNET
703456OtherCONNECTICARE
=========OtherHMC PPO
=========OtherORTHONET
=========OtherUNITED HEALTHCARE
509196OtherAETNA US HEALTHCARE
703456OtherCONNECTICARE
=========OtherHMC PPO