Basic Information
| Provider Information | |||||||||
| NPI: | 1326125212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLATT | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061071926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602744092 | ||||||||
| FaxNumber: | 8602744099 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GUILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064372003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034532844 | ||||||||
| FaxNumber: | 2034538772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6358 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 080006358CT22 | 01 | CT | ANTHEM BC BS | OTHER | CG5311 | 01 | CT | RAILROAD MEDICARE | OTHER | 080006358CT24 | 01 | CT | ANTHEM BC BS | OTHER | 080006358CT25 | 01 | CT | ANTHEM BC BS | OTHER | 004191227 | 05 | CT | MEDICAID | 080006358CT21 | 01 | CT | ANTHEM BC BS | OTHER |