Provider Demographics
NPI:1699941518
Name:BELANGER, JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BELANGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1408
Mailing Address - Country:US
Mailing Address - Phone:860-295-0572
Mailing Address - Fax:860-295-1201
Practice Address - Street 1:8 INDEPENDENCE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1408
Practice Address - Country:US
Practice Address - Phone:860-295-0572
Practice Address - Fax:860-295-1201
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT08-0004745CT02OtherANTHEM BLUE CROSS/ BLUE SHIELD