Active NPI
Ethan Ryan Dickinson, DPT
- Physical Therapist
- Windsor, CT
National Provider Identifier
1497313811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12325
- Practice address
- 1080 Day Hill Rd
Windsor, CT 06095-1781 - Phone
- (860) 298-8442
- NPI assigned
- May 31, 2019
- 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 | 12325 | CT | Primary |
Addresses
Primary practice location
1080 Day Hill Rd
Windsor, CT 06095-1781
Mailing address
55 Overlook Way
Canaan, NH 03741-7101
Phone (603) 359-7746
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12325 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1497313811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 OVERLOOK WAY",
"city": "CANAAN",
"state": "NH",
"postal_code": "037417101",
"telephone_number": "603-359-7746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 DAY HILL RD",
"city": "WINDSOR",
"state": "CT",
"postal_code": "060951781",
"telephone_number": "860-298-8442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKINSON",
"first_name": "ETHAN",
"middle_name": "RYAN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-31",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "12325",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.