Active NPI
Carlo Sandico, PT
- Physical Therapist
- Bridgeport, CT
National Provider Identifier
1386164200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12588
- Practice address
- 765 Fairfield Ave
Bridgeport, CT 06604-3702 - Phone
- (860) 736-7657
- NPI assigned
- Jun 21, 2017
- Last updated
- Jun 27, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12588 | CT | Primary |
Addresses
Primary practice location
765 Fairfield Ave
Bridgeport, CT 06604-3702
Mailing address
612 Corey LN
Champaign, IL 61822-1047
Other practice location 1
612 Corey Lane
Champagne, IL 61822
Phone (407) 961-6363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12588 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656288000000",
"number": "1386164200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 COREY LN",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618221047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "765 FAIRFIELD AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066043702",
"telephone_number": "860-736-7657"
}
],
"practiceLocations": [
{
"address_1": "612 Corey Lane",
"address_purpose": "LOCATION",
"city": "Champagne",
"state": "IL",
"postal_code": "61822",
"country_code": "US",
"telephone_number": "407-961-6363",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SANDICO",
"first_name": "CARLO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-21",
"last_updated": "2022-06-27",
"certification_date": "2022-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "12588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.