Performance Edge Sports, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PERFORMANCE EDGE SPORTS, LLC

Practice address

7 Park Ave
Suite 4
Colchester, CT 06415-1128

Phone

(860) 531-3222

Fax

(860) 531-3224

NPI assigned

Sep 3, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Anthony J Todt, MSPT, CSCS

Title

Owner

Phone

(860) 917-6536

Specialties & licenses 1

Addresses

Other names 1

• Family Physical Therapy Doing business as

Locations

Practitioners 2

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

• Jennifer Grandpre, DPT

  • Physical Therapist
  • Colchester, CT
  • NPI 1235488701
  NPD
• Rebecca Wengloski, PTA

  • Physical Therapy Assistant
  • Colchester, CT
  • NPI 1114264207
  NPD (past)

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"
        }
    ]
}

• Shraddha Patel
• Debra Pearson
• Janet F Peck, LPC
• Heather Pelletier, LPC
• Penny for Our Thoughts LLC
• Performance Physical Therapy & Sports Medicine, Inc
• Personal Exporations, LLC
• Stephanie Pineiro, PA-C
• Amy Pinnock-Robinson, LCSW
• Natalia Pisklak

• Physical Therapist in Colchester, CT
• Providers in Colchester, CT by specialty
• Physical Therapist in Connecticut

• 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.