Jake Christian Sasis
Individual provider Active NPI Physical Therapist · Redding, CT
NPI 1417455304 · NPPES record last updated Mar 14, 2023
Key facts
- NPI
- 1417455304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 80 Portland Ave
Redding, CT 06896-3113 - Phone
- (906) 231-0022
- NPI assigned
- Jan 25, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- JMS Therapeutics LLC
Practice addresses (Care Compare)
Norwalk, CT 06850
Phone (718) 775-6978
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191023001345 | CT | Practitioner - Physical Therapist in Private Practice | 4880926930 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11880 | CT | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Yes |
Addresses
Primary practice location
80 Portland Ave
Redding, CT 06896-3113
Mailing address
80 Portland Ave
Redding, CT 06896-3113
Phone (906) 231-0022
Other providers in Redding, CT
- Eleanor Rigby
- Joanne Ross
- Anita Ora Rothman
- Cynthia Emiry Roy
- Leslie Rubury
- David Schoenberg
- Georgina Bates Scholl
- Nanette Rose Seligman Greene
- Mary Elizabeth E Sheridan
- Anne Shields
All providers in Redding, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.