Brian Isamu Aida
Individual provider Active NPI Physical Therapist · Portland, CT
NPI 1215053350 · NPPES record last updated Jan 20, 2025
Key facts
- NPI
- 1215053350
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 007989 (CT)
- Practice address
- 9 Grove St
Portland, CT 06480-1956 - Phone
- (973) 224-2401
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2006
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
9 Grove St
Portland, CT 06480-1956
PO Box
821322 Attn Powerback Credentialing Dept
Philadelphia, PA 19182-1322
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260603003004 | CT | Practitioner - Physical Therapist in Private Practice | 8729559422 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007989 | CT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 007989 | CT | Yes |
Addresses
Primary practice location
9 Grove St
Portland, CT 06480-1956
Mailing address
9 Grove St
Portland, CT 06480-1956
Phone (973) 224-2401
Other providers in Portland, CT
- 260 Main St Portland Inc
- Yadira E. Acevedo
- Joseph Aferzon
- Affirmation Counseling Center Inc
- Amita Aggarwal
- Amita Aggarwal, DMD, LLC
- Yvette Lynn Anderson
- Applied Physical Therapy & Wellness, LLC
- Lindsey Arcand
- Keith Arcari
All providers in Portland, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.