NPIMap

Organization Active NPI

Central CT Sports Medicine Center

  • Physical Therapist
  • Berlin, CT
National Provider Identifier
1104982826
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CENTRAL CT SPORTS MEDICINE CENTER
Practice address
15 Massirio Dr
Berlin, CT 06037-2322
Phone
(860) 829-1300
Fax
(860) 829-1388
NPI assigned
Dec 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Authorized official

Name
Mrs. Cathy A. Fellows
Title
Business Manager
Phone
(860) 829-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

15 Massirio Dr
Berlin, CT 06037-2322

Mailing address

15 Massirio Dr
Berlin, CT 06037-2322
Phone (860) 829-1300

Other names 1

  • Central CT Physical Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

15 Massirio Dr
Berlin, CT 06037
Phone (860) 829-1300

15 Massirio Dr
Ste 102
Berlin, CT 06037
Phone (860) 829-1300

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1104982826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MASSIRIO DR",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060372322",
            "telephone_number": "860-829-1300",
            "fax_number": "860-829-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MASSIRIO DR",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060372322",
            "telephone_number": "860-829-1300",
            "fax_number": "860-829-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CT SPORTS MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "FELLOWS",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "860-829-1300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central CT Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berlin, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.