Active NPI
Philip Jay Stevenson, ATC LAT
- Athletic Trainer
- West Hartford, CT
National Provider Identifier
1225501976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 001270
- Practice address
- 200 Bloomfield Ave
West Hartford, CT 06117-1599 - Phone
- (623) 521-6312
- NPI assigned
- Jan 5, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 001270 | CT | Primary |
Addresses
Primary practice location
200 Bloomfield Ave
West Hartford, CT 06117-1599
Mailing address
47 Village LN Apt 811
Wethersfield, CT 06109-1084
Phone (623) 521-6312
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001270 | CT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546646400000",
"number": "1225501976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 VILLAGE LN APT 811",
"city": "WETHERSFIELD",
"state": "CT",
"postal_code": "061091084",
"telephone_number": "623-521-6312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BLOOMFIELD AVE",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061171599",
"telephone_number": "623-521-6312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "PHILIP",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "ATC LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-05",
"last_updated": "2019-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "001270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.