Physical Therapy and Wellness Treatment Center, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

003246 Issued in CT

Legal business name

PHYSICAL THERAPY AND WELLNESS TREATMENT CENTER, LLC

Practice address

168 Boston Post Rd
Suite 3
Madison, CT 06443-2163

Phone

(203) 245-1881

Fax

(203) 421-8388

NPI assigned

Jan 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Susan Kenney, PTNPI 1104976919

Title

Owner

Phone

(203) 245-1881

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan E Kenney, PT

  • Physical Therapist
  • Madison, CT
  • NPI 1104976919
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1003961822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 CANLEWOOD LA",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064431914",
            "telephone_number": "203-245-1881",
            "fax_number": "203-421-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 BOSTON POST RD",
            "address_2": "SUITE 3",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432163",
            "telephone_number": "203-245-1881",
            "fax_number": "203-421-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY AND WELLNESS TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "KENNEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-245-1881",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "003246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003961822",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Lee Petersen
• W. Dean Pfeifer, PHD
• Physical Therapy Center of Madison
• Taylor Marie Pisano, LMFT
• Christina Marie Polk
• Positive Choices Therapy, LLC
• Carol Gray Potter, OTR/L, BCG, CAPS

• Physical Therapist in Madison, CT
• Providers in Madison, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.