Nicole Ann Bacon, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

008144 Issued in CT

Practice address

255 N Main St
Bristol, CT 06010-4972

Phone

(860) 589-1881

Fax

(860) 583-1512

NPI assigned

Aug 6, 2007

Last updated

Jan 5, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Glastonbury, CT
  • NPI 1174493126
  Medicare reassignment

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262649600000",
    "number": "1437340361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 N MAIN ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104972",
            "telephone_number": "860-589-1881",
            "fax_number": "860-583-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N MAIN ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104972",
            "telephone_number": "860-589-1881",
            "fax_number": "860-583-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2010-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "008144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Adele Austin, PHARMD
• Tanya Chiarelli Ave'Lallemant, MD
• Awakened Potential Therapy
• Jody Elizabeth Axt
• Ellen D Babcock, LMFT
• Carlos Manuel Badiola, MD
• Ara D Bagdasarian, MD
• Rainer Wolf Bagdasarian, MD
• Fatoumata Bah, NURSE PRACTITIONER
• Lea Bailey, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.