| Organization Name: | BOLTON PHYSICAL THERAPY & SPORTS PERFORMANCE LLC |
| NPI Number: | 1265650188 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRUCE ALAN LANGEVIN (OWNER) |
| Mailing Address: | 921 Boston Turnpike Bolton |
| State: | CT US |
| Postal Code: | 06043 |
| Phone Number: | 8606468758 |
| Fax Number: | 8606460256 |
| NPI Enumeration Date: | 04/23/2007 |
| NPI Last Update Date: | 07/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 005532 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |