Supreme Physical Therapy and Wellness Rehabilitation Center

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SUPREME PHYSICAL THERAPY AND WELLNESS REHABILITATION CENTER

Practice address

1825 Barnum Ave Ste 304
Stratford, CT 06614-5333

Phone

(475) 328-0009

Fax

(203) 212-8528

NPI assigned

Mar 11, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Ilicia Mathis, DPTNPI 1770951956

Title

Co- Owner

Phone

(475) 328-0009

Specialties & licenses 1

Addresses

Practitioners 1

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

• Ilicia Mathis, DPT

  • Physical Therapist
  • Hamden, CT
  • NPI 1770951956
  NPD Authorized official

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1376301614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 LAYDON AVE",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064732704",
            "telephone_number": "203-584-3748",
            "fax_number": "203-212-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 BARNUM AVE STE 304",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066145333",
            "telephone_number": "475-328-0009",
            "fax_number": "203-212-8528"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 Waverly St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770074527",
            "country_code": "US",
            "telephone_number": "832-781-0100",
            "fax_number": "203-212-8528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUPREME PHYSICAL THERAPY AND WELLNESS REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "ILICIA",
        "authorized_official_title_or_position": "CO- OWNER",
        "authorized_official_telephone_number": "475-328-0009",
        "authorized_official_name_prefix": "Dr.",
        "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": []
}

• Stratford Pediatrics, Inc.
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• Bruce John Swearingen Jr., MD
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• Tapestry Health PLLC

• Physical Therapist in Stratford, CT
• Providers in Stratford, 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 11, 2024; 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.