Provider Demographics
NPI:1780868505
Name:FOCUS PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:FOCUS PHYSICAL THERAPY & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:413-219-7923
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-0452
Mailing Address - Country:US
Mailing Address - Phone:860-829-5511
Mailing Address - Fax:860-829-5577
Practice Address - Street 1:1138 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2301
Practice Address - Country:US
Practice Address - Phone:860-829-5511
Practice Address - Fax:860-829-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy