Provider Demographics
NPI:1730374570
Name:PRIOR, PHILIP M (MSPT)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:PRIOR
Suffix:
Gender:M
Credentials:MSPT
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Other - Last Name:
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Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-294-6734
Practice Address - Street 1:1 GREENWICH PL
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7603
Practice Address - Country:US
Practice Address - Phone:203-538-0021
Practice Address - Fax:203-466-8527
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT008692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1730374570Medicaid
D400063202Medicare PIN