Bolton Physical Therapy & Sports Performance LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

005532 Issued in CT

Legal business name

BOLTON PHYSICAL THERAPY & SPORTS PERFORMANCE LLC

Practice address

921 Boston Turnpike
Bolton, CT 06043

Phone

(860) 646-8758

Fax

(860) 646-0256

NPI assigned

Apr 23, 2007

Last updated

Jul 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bruce Alan Langevin, PHYSICAL THERAPISTNPI 1992888531

Title

Owner

Phone

(860) 646-8758

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 2

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.

• Bruce Alan Langevin

  • Orthopedic Physical Therapist
  • Bolton, CT
  • NPI 1992888531
  Medicare reassignment Care Compare group NPD Authorized official
• Michelle Tsirovasiles, PT

  • Physical Therapist
  • Glastonbury, CT
  • NPI 1962468272
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342137600000",
    "number": "1265650188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9518",
            "city": "BOLTON",
            "state": "CT",
            "postal_code": "060439518",
            "telephone_number": "860-646-8758",
            "fax_number": "860-646-0256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 BOSTON TURNPIKE",
            "city": "BOLTON",
            "state": "CT",
            "postal_code": "06043",
            "telephone_number": "860-646-8758",
            "fax_number": "860-646-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLTON PHYSICAL THERAPY & SPORTS PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2012-07-13",
        "status": "A",
        "authorized_official_last_name": "LANGEVIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-646-8758",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CT",
            "license": "005532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLE SHIELD",
            "identifier": "080005532CT08",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET CIGNA",
            "identifier": "44901",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET HEALTHNET",
            "identifier": "0044901",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Anzures, MA SLP-CCC
• Bolton Board of Education
• Bolton Lake Dental LLC
• Bolton Pharmacy Inc
• Megan A Bouffard, ABOC NCLEC
• Monique Marie Brunelle, DNP, APRN, FNP-BC
• Ronald L Buckman, M.D.
• Marikate Carabase
• Casey Carini, DNP, AGPCNP-BC

• Physical Therapy Clinic/Center in Bolton, CT
• Providers in Bolton, CT by specialty
• Physical Therapy Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.