Rebecca A Petersen, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

919 Issued in CT

Practice address

1 Blachley Rd
2ND Floor, Orthopedic and Spine Institute
Stamford, CT 06902-0001

Phone

(203) 276-8495

Fax

(203) 276-2282

NPI assigned

Sep 26, 2006

Last updated

Nov 15, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Rebecca A Powell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ABCIBA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stamford Health Medical Group Inc

  • General Practice Physician
  • Stamford, CT
  • NPI 1154633980
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384473600000",
    "number": "1366543977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BLACHLEY RD",
            "address_2": "2ND FLOOR, ORTHOPEDIC AND SPINE INSTITUTE",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069020001",
            "telephone_number": "203-276-8495",
            "fax_number": "203-276-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BLACHLEY RD",
            "address_2": "2ND FLOOR, ORTHOPEDIC AND SPINE INSTITUTE",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069020001",
            "telephone_number": "203-276-8495",
            "fax_number": "203-276-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "REBECCA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2013-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "000664-1",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CT",
            "license": "919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "POWELL",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Personalized Home Care, LTD. of Connecticut
• Keesha Pesce, LCSW
• Peter Laforte M D P C
• Peter Y Siroka DPM PC
• Skylar Peters, LCSW
• Cristian Petre, MSPT
• Alexandra Petrov, IBCLC
• Linda Pettei, NP
• Ryan David Pettit, MD
• Peyser Chiropractic

• Athletic Trainer in Stamford, CT
• Providers in Stamford, CT by specialty
• Athletic Trainer in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.