Provider Demographics
NPI:1689656779
Name:CHAPDELAINE, THOMAS J (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CHAPDELAINE
Suffix:
Gender:M
Credentials:PT
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Other - Credentials:
Mailing Address - Street 1:435 HARTFORD TPKE
Mailing Address - Street 2:SUITE U
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4852
Mailing Address - Country:US
Mailing Address - Phone:860-979-1611
Mailing Address - Fax:203-866-3014
Practice Address - Street 1:144 MORGAN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5433
Practice Address - Country:US
Practice Address - Phone:203-965-0609
Practice Address - Fax:203-965-0623
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2016-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT002435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000293Medicare ID - Type Unspecified