NPIMap

Organization Active NPI

Stride Physical Therapy and Pedorthic Center, PC

  • Durable Medical Equipment & Medical Supplies
  • Middlebury, CT
National Provider Identifier
1518088723
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
003621 Issued in CT
Legal business name
STRIDE PHYSICAL THERAPY AND PEDORTHIC CENTER, PC
Practice address
80 Turnpike Dr
Unit 1
Middlebury, CT 06762-1830
Phone
(203) 758-8307
Fax
(203) 758-8394
NPI assigned
Apr 3, 2007
Last updated
Oct 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Roberta T Nole, MA PT CPCNPI 1700064979
Title
President
Phone
(203) 758-8307

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 003621 CT Primary

Addresses

Primary practice location

80 Turnpike Dr
Unit 1
Middlebury, CT 06762-1830

Mailing address

80 Turnpike Dr
Unit 1
Middlebury, CT 06762-1830
Phone (203) 758-8307

Other identifiers 2

IdentifierTypeStateIssuer
080003621CT02OtherCTANTHEM
004137338MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050822001288 CT Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779514534 Receives reassigned benefits from 1 practitioner
Practice locations: Middlebury, CT
O20100930032479 CT DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Orthotic PersonnelDME Supplier - Pedorthic Personnel 3779514534 Practice locations: Middlebury, CT

National Provider Directory

National Provider Directory

Locations

80 Turnpike Dr
Ste 1
Middlebury, CT 06762
Phone (203) 758-8307

Practitioners & affiliated clinicians

Practitioners 7

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": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1518088723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 TURNPIKE DR",
            "address_2": "UNIT 1",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067621830",
            "telephone_number": "203-758-8307",
            "fax_number": "203-758-8394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 TURNPIKE DR",
            "address_2": "UNIT 1",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067621830",
            "telephone_number": "203-758-8307",
            "fax_number": "203-758-8394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRIDE PHYSICAL THERAPY AND PEDORTHIC CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "NOLE",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-758-8307",
        "authorized_official_credential": "MA PT CPC"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "003621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "080003621CT02",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004137338",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.