Provider Demographics
NPI:1760699904
Name:TOLLAND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TOLLAND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:860-875-4816
Mailing Address - Street 1:384 MERROW RD STE B
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3971
Mailing Address - Country:US
Mailing Address - Phone:860-875-4816
Mailing Address - Fax:860-875-2053
Practice Address - Street 1:384 MERROW RD STE B
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3971
Practice Address - Country:US
Practice Address - Phone:860-875-4816
Practice Address - Fax:860-875-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V1704OtherHEALTHNET PROVIDER NUMBER
CTA685551OtherOXFORD PROVIDER NUMBER
CTCO1229Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER