Provider Demographics
NPI:1699966648
Name:CIABURRI, ANTHONY P (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:CIABURRI
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 1:27 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2601
Mailing Address - Country:US
Mailing Address - Phone:860-274-4092
Mailing Address - Fax:860-274-4099
Practice Address - Street 1:5 PEQUOT PARK ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498
Practice Address - Country:US
Practice Address - Phone:860-399-6411
Practice Address - Fax:860-399-6822
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080008145CT03OtherBLUE CROSS BLUE SHIELD
CT080008145CT01OtherBLUE CROSS BLUE SHIELD
CT080008145CT02OtherBLUE CROSS BLUE SHIELD