Active NPI
Nathan Collette
- Physical Therapist
- Milford, CT
National Provider Identifier
1073569455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 005875
- Practice address
- 258 Broad St
Milford, CT 06460-3226 - Phone
- (203) 882-5632
- Fax
- (203) 882-7200
- NPI assigned
- May 26, 2006
- Sex
- Male
- 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 | 005875 | CT | Primary |
Addresses
Primary practice location
258 Broad St
Milford, CT 06460-3226
Mailing address
2408 Whitney Ave
PO Box 5576
Hamden, CT 06518-3209
Phone (203) 407-3500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080005875CT03 | Other | CT | ANTHEM BCBS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005875 | CT | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190073600000",
"number": "1073569455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2408 WHITNEY AVE",
"address_2": "PO BOX 5576",
"city": "HAMDEN",
"state": "CT",
"postal_code": "065183209",
"telephone_number": "203-407-3500",
"fax_number": "203-281-1164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "258 BROAD ST",
"city": "MILFORD",
"state": "CT",
"postal_code": "064603226",
"telephone_number": "203-882-5632",
"fax_number": "203-882-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLETTE",
"first_name": "NATHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2007-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "005875",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "080005875CT03",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.