NPIMap

Organization Active NPI

Orthopedic Physical Therapy of Southern New England LLC

  • Specialist
  • Norwich, CT
National Provider Identifier
1043488059
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
003827 Issued in CT
Legal business name
ORTHOPEDIC PHYSICAL THERAPY OF SOUTHERN NEW ENGLAND LLC
Practice address
7 Clinic Dr
Norwich, CT 06360-2915
Phone
(860) 887-6408
Fax
(860) 887-6592
NPI assigned
Feb 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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

Authorized official

Name
Steven Kenneth Gamble, MS, PTNPI 1568474484
Title
Physical Therapist/Owner
Phone
(860) 887-6408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 003827 CT Primary

Addresses

Primary practice location

7 Clinic Dr
Norwich, CT 06360-2915

Mailing address

7 Clinic Dr
Norwich, CT 06360-2915
Phone (860) 887-6408

Other identifiers 2

IdentifierTypeStateIssuer
C03410OtherCTMEDICARE GROUP NUMBER
650001190OtherCTMEDICARE ID NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051007000486 CT Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9133144223 Receives reassigned benefits from 1 practitioner
Practice locations: Norwich, CT

National Provider Directory

National Provider Directory

Locations

3 Mill St
Mystic, CT 06355
Phone (860) 536-8988

219 W Town St
Ste A
Norwich, CT 06360
Phone (860) 887-6408

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1043488059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 CLINIC DR",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602915",
            "telephone_number": "860-887-6408",
            "fax_number": "860-887-6592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 CLINIC DR",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602915",
            "telephone_number": "860-887-6408",
            "fax_number": "860-887-6592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC PHYSICAL THERAPY OF SOUTHERN NEW ENGLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "860-887-6408",
        "authorized_official_credential": "MS, PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "003827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C03410",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID NUMBER",
            "identifier": "650001190",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.