Provider Demographics
NPI:1578649356
Name:DURANT, TIMOTHY LINDSAY (MSPT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LINDSAY
Last Name:DURANT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8286 WOLCOTT HILL ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-436-2252
Mailing Address - Fax:860-436-6175
Practice Address - Street 1:2928 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1007
Practice Address - Country:US
Practice Address - Phone:860-430-2344
Practice Address - Fax:860-430-2349
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V7374OtherHEATHNET
080005973CT22OtherBCBS
574277OtherAETNA
7496257OtherCIGNA
CT650001116Medicare ID - Type Unspecified