Provider Demographics
NPI:1871764001
Name:AEON PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:AEON PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS
Authorized Official - Phone:203-313-7762
Mailing Address - Street 1:238 MONROE TPKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2247
Mailing Address - Country:US
Mailing Address - Phone:203-313-7762
Mailing Address - Fax:
Practice Address - Street 1:238 MONROE TPKE
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2247
Practice Address - Country:US
Practice Address - Phone:203-313-7762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007471261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy