Individual provider Active NPI

Sara Jane Tine

  • Physical Therapist
  • New Haven, CT
National Provider Identifier
1366848962
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10325 Issued in CT
Practice address
230 George St
New Haven, CT 06510-3224
Phone
(203) 498-5980
NPI assigned
Nov 8, 2014
Last updated
Nov 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10325 CT Primary

Addresses

Primary practice location

230 George St
New Haven, CT 06510-3224

Mailing address

230 George St
New Haven, CT 06510-3224

Other names 1

  • Sara Jane Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180712000996 CT Practitioner - Physical Therapist in Private Practice 0648526228 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10325CTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Orthopaedics LLC CurrentSince Dec 1, 2019 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Nov 13, 2023 Accepting new patients
Orthopedic Associates of Hartford,PC CurrentSince Jul 9, 2018 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Nov 13, 2023 Accepting new patients
Orthopedic Associates of Hartford,PC CurrentSince Jul 9, 2018 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist PastSince May 2, 2026 Accepting new patients

Locations

641 Clark Ave
Ste A
Bristol, CT 06010
Phone (860) 582-0389

641 Clark Ave
Ste B
Bristol, CT 06010
Phone (860) 582-6603

31 Seymour St
Ste 100
Hartford, CT 06106
Phone (860) 549-8276

201 N Mountain Rd
Ste 302
Plainville, CT 06062
Phone (860) 348-9338

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (919) 861-2441

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1415404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1366848962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 GEORGE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 GEORGE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103224",
            "telephone_number": "203-498-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINE",
        "first_name": "SARA",
        "middle_name": "JANE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-08",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "10325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "SMITH",
            "middle_name": "JANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.