Pryme Physical Therapy & Sports Medicine LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PRYME PHYSICAL THERAPY & SPORTS MEDICINE LLC

Practice address

12 Ocean Ave
West Haven, CT 06516-7048

Phone

(203) 561-7714

NPI assigned

Dec 7, 2022

Organization subpart

No

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

Authorized official

Name

Michael Johnson, DPTNPI 1255685723

Title

Owner

Phone

(860) 422-0878

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Johnson, DPT, OCS, CSCS

  • Sports Physical Therapist
  • West Haven, CT
  • NPI 1255685723
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1285345637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16573",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065160983",
            "telephone_number": "860-422-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 OCEAN AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065167048",
            "telephone_number": "203-561-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRYME PHYSICAL THERAPY & SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-07",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-422-0878",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee G. Prajer, RDH, MS
• Jessica Susan Preston, M.S
• Edward Prior, M.D.
• Petr Protiva, MD
• Amy Provencal, PTA
• Psychologist Adriana L Gonzalez PHD PLLC
• Kerry Puglia, NP
• Qaiyum Mujtaba, M.D., P.C.
• Quality Staffing Home Care, Inc.
• Marci Ann Quaranta, APRN

• Physical Therapist in West Haven, CT
• Providers in West Haven, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.