Basic Information
| Provider Information | |||||||||
| NPI: | 1083752109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENT PHYSICAL THERAPY, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34 | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067570034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609274559 | ||||||||
| FaxNumber: | 8609273352 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067570034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609274559 | ||||||||
| FaxNumber: | 8609273352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DEBOER | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8609274559 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004720 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7535921004 | 01 | CT | CIGNA PROVIDER | OTHER | P2057224 | 01 | NY | OXFORD OUT OF NETWORK PRO | OTHER | OV6316 | 01 | CT | HEALTH NET PROVIDER | OTHER | 0015901 | 01 | CT | ORTHONET HEALTH NET PROVI | OTHER | 64-04275 | 01 | CT | UNITED HEALTH CARE PROVID | OTHER | 15901 | 01 | CT | CIGNA ORTHONET PROVIDER | OTHER | 2288136 | 01 | CT | AETNA PROVIDER | OTHER |