NPIMap

Organization Active NPI

Performance Physical Therapy of New Canaan, PLLC

Doing business as Performance Physical Therapy and Wellness

  • Physical Therapy Clinic/Center
  • New Canaan, CT
National Provider Identifier
1194282004
Registry record updated Mar 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PERFORMANCE PHYSICAL THERAPY OF NEW CANAAN, PLLC
Doing business as
Performance Physical Therapy and Wellness
Practice address
16 Cross St
New Canaan, CT 06840-4831
Phone
(203) 422-0679
Fax
(203) 621-3162
NPI assigned
Feb 27, 2019
Last updated
Mar 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2019

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

Authorized official

Name
Simone Burke
Title
Billing Manager
Phone
(203) 553-7626

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

16 Cross St
New Canaan, CT 06840-4831

Mailing address

PO Box 402
Cos Cob, CT 06807-0402
Phone (203) 553-7626

Other names 1

  • Performance Physical Therapy and Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190321001142 CT Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365782745 Receives reassigned benefits from 14 practitioners
Practice locations: New Canaan, CT

National Provider Directory

National Provider Directory

Locations

16 Cross St
New Canaan, CT 06840
Phone (203) 228-5010

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552003200000",
    "number": "1194282004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 402",
            "city": "COS COB",
            "state": "CT",
            "postal_code": "068070402",
            "telephone_number": "203-553-7626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 CROSS ST",
            "city": "NEW CANAAN",
            "state": "CT",
            "postal_code": "068404831",
            "telephone_number": "203-422-0679",
            "fax_number": "203-621-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY OF NEW CANAAN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-03-08",
        "status": "A",
        "authorized_official_last_name": "BURKE",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "203-553-7626"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Performance Physical Therapy and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Performance Physical Therapy and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Canaan, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.