David M Donnelly, RPT
Individual provider Active NPI Physical Therapist · Wolcott, CT
NPI 1003853870 · NPPES record last updated Jan 21, 2015
Key facts
- NPI
- 1003853870
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 006743 (CT)
- Practice address
- 465 Wolcott Rd
Wolcott, CT 06716-2613 - Phone
- (203) 879-0107
- Fax
- (203) 879-0206
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advanced Physical Therapy, LLC
Practice addresses (Care Compare)
465 Wolcott Rd
Wolcott, CT 06716-2613
Phone (203) 441-4261
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050317000503 | CT | Practitioner - Physical Therapist in Private Practice | 4486609989 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6743 | CT | MD | Professional Counselor |
| 006743 | CT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopedic Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
| Community Physical Therapy | Physical Therapist | Past |
Accepting new patients |
| Michael Daley | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 006743 | CT | Yes |
Addresses
Primary practice location
465 Wolcott Rd
Wolcott, CT 06716-2613
Mailing address
465 Wolcott Rd
Wolcott, CT 06716-2613
Phone (203) 879-0107
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004212619 | Medicaid | CT |
Other providers in Wolcott, CT
- Shameka Dennis
- Dental Health Associates P.C.
- Didomizio Health & Rehabilitation
- Paul Michael Didomizio
- Erica Marie Dipietro
- Tara Donnelly
- Jayra Dorso
- Pamela Lynn Doubleday
- Sheanell Dougall
- Shakaya Douglas
All providers in Wolcott, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.