Provider Demographics
NPI:1508042896
Name:JOHN, STANLEY ABRAHAM (PT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ABRAHAM
Last Name:JOHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:ABRAHAM
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3105
Mailing Address - Country:US
Mailing Address - Phone:860-404-2201
Mailing Address - Fax:
Practice Address - Street 1:HFSC,2150 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIATIN
Practice Address - State:CT
Practice Address - Zip Code:06053
Practice Address - Country:US
Practice Address - Phone:860-827-1958
Practice Address - Fax:860-827-4947
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist