Basic Information
| Provider Information | |||||||||
| NPI: | 1427036805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAUGHLIN PHYSICAL THERAPY & SPORTS MEDICINE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 S CENTER ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606215054 | ||||||||
| FaxNumber: | 8606200270 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 S CENTER ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606215054 | ||||||||
| FaxNumber: | 8606200270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCLAUGHLIN | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8606215054 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 080002404CT03 | 01 | ANTHEM BLUE CROSS BLUE SH | OTHER | 509196 | 01 | AETNA US HEALTHCARE | OTHER | P451833 | 01 | OXFORD HEALTH PLANS | OTHER | OVO867 | 01 | HEALTHNET | OTHER | 703456 | 01 | CONNECTICARE | OTHER |