Individual provider Active NPI

Kyleen O Sidwell, DPT

  • Physical Therapist
  • Putnam, CT
National Provider Identifier
1043745326
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
011230 Issued in CT
Practice address
39 Kennedy Dr
Putnam, CT 06260-1957
Phone
(860) 963-2174
Fax
(860) 963-2178
NPI assigned
Apr 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 011230 CT Primary

Addresses

Primary practice location

39 Kennedy Dr
Putnam, CT 06260-1957

Mailing address

35 Kennedy Dr
Putnam, CT 06260-1939
Phone (860) 963-2133

Other names 1

  • Kyleen Magiera Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170517001061 CT Practitioner - Physical Therapist in Private Practice 9638446974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anb-Ptsma Holdings IncGroup PAC ID 4789572926, 190 clinicians

Practice addresses (Care Compare)

133 S Main St
West Hartford, CT 06107-3431
Phone (860) 940-2001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Anb-Ptsma Holdings, Inc. Physical Therapist CurrentSince Jan 3, 2022 Accepting new patients
Sacred Heart University, Inc Physical Therapist Past Accepting new patients

Locations

136 Main St
Danielson, CT 06239
Phone (860) 774-7001

103 E Main St
Unit C
Plainville, CT 06062
Phone (860) 517-8885

39 Kennedy Dr
Putnam, CT 06260
Phone (860) 963-2133

47 N Main St
West Hartford, CT 06107
Phone (860) 409-4595

133 S Main St
West Hartford, CT 06107
Phone (860) 409-4595

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1493078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1043745326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 KENNEDY DR",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601939",
            "telephone_number": "860-963-2133",
            "fax_number": "860-963-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 KENNEDY DR",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601957",
            "telephone_number": "860-963-2174",
            "fax_number": "860-963-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDWELL",
        "first_name": "KYLEEN",
        "middle_name": "O",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-25",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "011230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLEEN",
            "last_name": "MAGIERA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Putnam, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.