Gina Tieri Pezzetti Carlstrom, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13169 Issued in MA

Practice address

545 Old Turnpike Rd
Rutland, VT 05701-7427

Phone

(617) 724-0125

NPI assigned

Oct 23, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vermont Sports Medicine CenterGroup PAC ID 2365334810, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vermont Sports Medicine Center

  • Occupational Therapist
  • Rutland, VT
  • NPI 1730103300

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Vermont Sports Medicine Center

  • Prosthetic/Orthotic Supplier
  • Rutland, VT
  • NPI 1689832594
  NPD

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427673600000",
    "number": "1215263496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 OLD TURNPIKE RD",
            "city": "MENDON",
            "state": "VT",
            "postal_code": "057017427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 OLD TURNPIKE RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057017427",
            "telephone_number": "617-724-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZZETTI CARLSTROM",
        "first_name": "GINA",
        "middle_name": "TIERI",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-23",
        "last_updated": "2015-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "13169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destinee Perkins
• Heather Perkins, CDE
• James Perry, M.D.
• Peter a. Lakatos, DMD, PC (Total Patient Care Dentistry)
• Peter C. Stickney, MD PC
• Amy Pfenning, PNP
• Pharmacy Health Services Inc (Wilcox Pharmacy)
• Mieshau Phillips
• Phoenix Counseling & Wellness, PLC (Lauren LaSante)
• David Wolfe Pierce

• Physical Therapist in Rutland, VT
• Providers in Rutland, VT by specialty
• Physical Therapist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.