NPIMap

Organization Active NPI

Performance Physical Therapy & Sports Medicine, Inc

  • Hand Occupational Therapist
  • Colchester, CT
National Provider Identifier
1225105448
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hand Occupational TherapistTaxonomy code 225XH1200X
Legal business name
PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE, INC
Practice address
171 Norwich Ave
Colchester, CT 06415-1274
Phone
(860) 537-3014
Fax
(860) 537-1420
NPI assigned
Nov 30, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Christopher Dipasquale, PTNPI 1497822639
Title
President
Phone
(860) 537-3014

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Geriatric Physical Therapist 2251G0304X
Hand Physical Therapist 2251H1200X
Neurology Physical Therapist 2251N0400X
Sports Physical Therapist 2251S0007X
Orthopedic Physical Therapist 2251X0800X
Hand Occupational Therapist 225XH1200X Primary

Addresses

Primary practice location

171 Norwich Ave
Colchester, CT 06415-1274

Mailing address

171 Norwich Ave
Colchester, CT 06415-1274
Phone (860) 537-3014

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111220000037 CT Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5991970071 Practice locations: Colchester, CT; Hebron, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225105448. Details of each certification follow.

  • CCN 076565 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 076565

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Feb 14, 1997
Last certification
Mar 21, 2019
Ownership / control type
Proprietary
Facility address
171 Norwich Avenue
Colchester, CT 06415

National Provider Directory

National Provider Directory

Locations

171 Norwich Ave
Colchester, CT 06415
Phone (860) 537-1420

21C Liberty Dr
Hebron, CT 06248
Phone (860) 228-4883

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1225105448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 NORWICH AVE",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151274",
            "telephone_number": "860-537-3014",
            "fax_number": "860-537-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 NORWICH AVE",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151274",
            "telephone_number": "860-537-3014",
            "fax_number": "860-537-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DIPASQUALE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-537-3014",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colchester, CT

Sources for this page

Verify at the official NPI Registry.