Provider Demographics
NPI:1013084540
Name:WHALEN, LAUREL A (PT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:WHALEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3236
Mailing Address - Country:US
Mailing Address - Phone:860-484-9546
Mailing Address - Fax:
Practice Address - Street 1:1001 FARMINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3990
Practice Address - Country:US
Practice Address - Phone:860-582-8024
Practice Address - Fax:860-585-0609
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist