Provider Demographics
NPI:1558157016
Name:SDM PT ATC LLC
Entity type:Organization
Organization Name:SDM PT ATC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:862-268-5647
Mailing Address - Street 1:146 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-1411
Mailing Address - Country:US
Mailing Address - Phone:862-268-5647
Mailing Address - Fax:
Practice Address - Street 1:146 ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-1411
Practice Address - Country:US
Practice Address - Phone:862-268-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy