Provider Demographics
NPI:1871775718
Name:FLANAGAN, SCOTT (BS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2627
Mailing Address - Country:US
Mailing Address - Phone:860-683-4603
Mailing Address - Fax:
Practice Address - Street 1:80 LAMBERTON RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2136
Practice Address - Country:US
Practice Address - Phone:860-683-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076572OtherMEDICARE GROUP ID