Organization
BOLTON PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE ALAN LANGEVIN PHYSICAL THERAPIST (OWNER)
(860) 646-8758
Entity
Organization
Contact information
Practice address
921 BOSTON TURNPIKE, BOLTON, CT 06043
(860) 646-8758
(860) 646-0256
Mailing address
PO BOX 9518, BOLTON, CT 06043-9518
(860) 646-8758
(860) 646-0256
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
005532
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0044901
ORTHONET HEALTHNET
CT
01
—
080005532CT08
BLUE CROSS BLE SHIELD
CT
01
—
44901
ORTHONET CIGNA
CT
Enumeration date
04/23/2007
Last updated
07/13/2012
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