NPIMap

Organization Active NPI

Performance Edge Sports, LLC

Doing business as Family Physical Therapy

  • Physical Therapist
  • Colchester, CT
National Provider Identifier
1437307485
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PERFORMANCE EDGE SPORTS, LLC
Doing business as
Family Physical Therapy
Practice address
7 Park Ave
Suite 4
Colchester, CT 06415-1128
Phone
(860) 531-3222
Fax
(860) 531-3224
NPI assigned
Sep 3, 2008
Last updated
Jun 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

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

Authorized official

Name
Mr. Anthony J Todt, MSPT, CSCSNPI 1356471049
Title
Owner
Phone
(860) 917-6536

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

7 Park Ave
Suite 4
Colchester, CT 06415-1128

Mailing address

7 Park Ave
Suite 4
Colchester, CT 06415-1128
Phone (860) 531-3222

Other names 1

  • Family Physical Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

7 Park Ave
Ste 4
Colchester, CT 06415
Phone (860) 531-3222

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370563200000",
    "number": "1437307485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PARK AVE",
            "address_2": "SUITE 4",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151128",
            "telephone_number": "860-531-3222",
            "fax_number": "860-531-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 PARK AVE",
            "address_2": "SUITE 4",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151128",
            "telephone_number": "860-531-3222",
            "fax_number": "860-531-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE EDGE SPORTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-03",
        "last_updated": "2013-06-07",
        "status": "A",
        "authorized_official_last_name": "TODT",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-917-6536",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT, CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.