Provider Demographics
NPI:1689865792
Name:THOMASTON PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:THOMASTON PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:860-283-2316
Mailing Address - Street 1:258 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1815
Mailing Address - Country:US
Mailing Address - Phone:860-283-2316
Mailing Address - Fax:860-283-6079
Practice Address - Street 1:258 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1815
Practice Address - Country:US
Practice Address - Phone:860-283-2316
Practice Address - Fax:860-283-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3784149OtherAETNA
CT6434282OtherCIGNA
CT080006109CT06OtherANTHEM BC/BS
CT1828889OtherUNITED HEALTHCARE
CTP00281232OtherRAILROAD MEDICARE
CT080006109CT06OtherANTHEM BLUECARE FAMILY
CT2V8292OtherHEALTHNET