Active NPI
Annemieke Ausloos Martino, PT, DPT
- Physical Therapist
- Wallingford, CT
National Provider Identifier
1245852151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 011923
- Practice address
- 22 Masonic Ave
Wallingford, CT 06492-3048 - Phone
- (203) 679-5900
- NPI assigned
- May 13, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 011923 | CT | Primary |
Addresses
Primary practice location
22 Masonic Ave
Wallingford, CT 06492-3048
Mailing address
556 Upper Grassy Hill Rd
Woodbury, CT 06798-3107
Phone (203) 470-0767
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 |
|---|---|---|---|
| 011923 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589328000000",
"number": "1245852151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "556 UPPER GRASSY HILL RD",
"city": "WOODBURY",
"state": "CT",
"postal_code": "067983107",
"telephone_number": "203-470-0767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 MASONIC AVE",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064923048",
"telephone_number": "203-679-5900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINO",
"first_name": "ANNEMIEKE",
"middle_name": "AUSLOOS",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-13",
"last_updated": "2020-05-13",
"certification_date": "2020-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "011923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.