Provider Demographics
NPI:1366294316
Name:STICK IT PHYSICAL THERAPY
Entity type:Organization
Organization Name:STICK IT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:860-315-2877
Mailing Address - Street 1:18 BALLOU ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1252
Mailing Address - Country:US
Mailing Address - Phone:860-315-2877
Mailing Address - Fax:
Practice Address - Street 1:31 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2804
Practice Address - Country:US
Practice Address - Phone:860-774-7425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty