Provider Demographics
NPI:1639209026
Name:TIMOTHY DURANT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TIMOTHY DURANT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSPT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-430-2344
Mailing Address - Street 1:2928 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1007
Mailing Address - Country:US
Mailing Address - Phone:860-430-2344
Mailing Address - Fax:860-430-2349
Practice Address - Street 1:2928 MAIN ST STE 2
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0249401OtherORTHONET INSURANCE
CT574277OtherAETNA INSURANCE
CT7496257OtherCIGNA PPO ONLY
CT0249401OtherORTHONET INSURANCE