Provider Demographics
NPI:1336256908
Name:DEBOER, ARLIN (PT)
Entity Type:Individual
Prefix:MR
First Name:ARLIN
Middle Name:
Last Name:DEBOER
Suffix:
Gender:M
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:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0034
Mailing Address - Country:US
Mailing Address - Phone:860-927-4559
Mailing Address - Fax:860-927-3352
Practice Address - Street 1:64 MAPLE ST.
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-0034
Practice Address - Country:US
Practice Address - Phone:860-927-4559
Practice Address - Fax:860-927-3352
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT575838OtherCONNECTICARE PROVIDER
CT15901OtherCIGNA ORTHONET PROVIDER
NYP2057224OtherOXFORD OUT OF NETWORK PRO
CT2288136OtherAETNA PROVIDER
CT64-04275OtherUNITED HEALTH CARE PROVID
CTOV6316OtherHEALTH NET PROVIDER
NYQA6291OtherEMPIRE
NY437034OtherMVP PROVIDER
CT0800004702CT01OtherANTHEM BC/BS PROVIDER