Basic Information
| Provider Information | |||||||||
| NPI: | 1699966648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIABURRI | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 DEPOT ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067952601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602744092 | ||||||||
| FaxNumber: | 8602744099 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 PEQUOT PARK ROAD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | WESTBROOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603996411 | ||||||||
| FaxNumber: | 8603996822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 10/26/2007 | ||||||||
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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 | 008145 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 080008145CT03 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER | 080008145CT01 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER | 080008145CT02 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER |