Provider Demographics
NPI:1194705780
Name:SWEET, DALE L JR (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:L
Last Name:SWEET
Suffix:JR
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARINE ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1470
Mailing Address - Country:US
Mailing Address - Phone:860-283-2316
Mailing Address - Fax:860-283-6079
Practice Address - Street 1:10 MARINE ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1470
Practice Address - Country:US
Practice Address - Phone:860-283-2316
Practice Address - Fax:860-283-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004190758Medicaid
CT6109OtherLICENSE
CTANTHEM BC/BSOtherPROVIDER ID NUMBER