Active NPI
Jamie Lynn Pedersen, RPT
- Physical Therapist
- Wallingford, CT
National Provider Identifier
1073170809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 104 S Turnpike Rd
Wallingford, CT 06492-4320 - Phone
- (888) 679-9997
- NPI assigned
- May 28, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
104 S Turnpike Rd
Wallingford, CT 06492-4320
Mailing address
104 S Turnpike Rd
Wallingford, CT 06492-4320
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jpedersen@masonicare.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559001600000",
"number": "1073170809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 S TURNPIKE RD",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064924320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S TURNPIKE RD",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064924320",
"telephone_number": "888-679-9997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "JAMIE",
"middle_name": "LYNN",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-28",
"last_updated": "2019-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jpedersen@masonicare.org",
"affiliation": "N",
"endpointDescription": "email",
"address_1": "104 S Turnpike Rd",
"city": "Wallingford",
"state": "CT",
"country_code": "US",
"postal_code": "064924320",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.