Provider Demographics
NPI:1700076932
Name:MCLAUGHLIN PT
Entity type:Organization
Organization Name:MCLAUGHLIN PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:860-621-5054
Mailing Address - Street 1:18 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3121
Mailing Address - Country:US
Mailing Address - Phone:860-621-5054
Mailing Address - Fax:860-620-0270
Practice Address - Street 1:18 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3121
Practice Address - Country:US
Practice Address - Phone:860-621-5054
Practice Address - Fax:860-620-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006858261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076558Medicare PIN