NPIMap

Organization Active NPI

Physical Therapy of Southern Connecticut, P.C.

  • Specialist
  • Derby, CT
National Provider Identifier
1164585451
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PHYSICAL THERAPY OF SOUTHERN CONNECTICUT, P.C.
Practice address
111 New Haven Ave
Derby, CT 06418-2197
Phone
(203) 735-8336
Fax
(203) 735-3704
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Linda Maude, RPT
Title
President
Phone
(203) 735-8336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X CT Primary

Addresses

Primary practice location

111 New Haven Ave
Derby, CT 06418-2197

Mailing address

111 New Haven Ave
Derby, CT 06418-2197
Phone (203) 735-8336

Other identifiers 4

IdentifierTypeStateIssuer
004398203MedicaidCT
50PTSOUTHPT01OtherCTANTHEM BLUE CROSS
OV1301OtherCTHEALTHNET
ANC1153OtherCTOXFORD HEALTH PLANS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1164585451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAVEN AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182197",
            "telephone_number": "203-735-8336",
            "fax_number": "203-735-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NEW HAVEN AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182197",
            "telephone_number": "203-735-8336",
            "fax_number": "203-735-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY OF SOUTHERN CONNECTICUT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MAUDE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-735-8336",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004398203",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "50PTSOUTHPT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OV1301",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "ANC1153",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.