Provider Demographics
NPI:1801918669
Name:TUTHILL, SHAWN (MSPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:TUTHILL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SALMON BROOK ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2607
Mailing Address - Country:US
Mailing Address - Phone:860-844-8912
Mailing Address - Fax:860-653-6395
Practice Address - Street 1:97 SALMON BROOK ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2607
Practice Address - Country:US
Practice Address - Phone:860-844-8912
Practice Address - Fax:860-653-6395
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076572Medicare ID - Type UnspecifiedGROUP ID#