NPIMap

Organization Active NPI

Magna Physical Therapy & Golf Medicine Center, LLC

  • Physical Therapy Clinic/Center
  • Avon, CT
National Provider Identifier
1548411234
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
004285 Issued in CT
Legal business name
MAGNA PHYSICAL THERAPY & GOLF MEDICINE CENTER, LLC
Practice address
302 W Main St
Suite 204
Avon, CT 06001-3681
Phone
(860) 679-0430
Fax
(860) 679-0431
NPI assigned
Oct 1, 2008
Last updated
Jan 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Authorized official

Name
Mr. Brian Albert Magna Sr., P.T.NPI 1194851444
Title
Owner
Phone
(860) 679-0430

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
Physical Therapy Clinic/Center 261QP2000X 004285 CT Primary

Addresses

Primary practice location

302 W Main St
Suite 204
Avon, CT 06001-3681

Mailing address

302 W Main St
Suite 204
Avon, CT 06001-3681
Phone (860) 679-0430

Other practice location 1

61 Maple Ave
Ste. 2
Canton, CT 06019-3058
Phone (860) 352-2463

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000180 CT Part B Supplier - Clinic/Group Practice 6901983329 Receives reassigned benefits from 7 practitioners
Practice locations: Avon, CT; Canton, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548411234. Details of each certification follow.

  • CCN 076587 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 076587

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MAGNA PHYSICAL THERAPY & GOLF MEDICINE CENTER, LLC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Aug 5, 2008
Last certification
Sep 26, 2019
Ownership / control type
Proprietary
Facility address
302 West Main Street, Suite 204
Avon, CT 06001

National Provider Directory

National Provider Directory

Locations

302 W Main St
Avon, CT 06001
Phone (860) 679-0430

302 W Main St
Ste 204
Avon, CT 06001
Phone (860) 679-0430

61 Maple Ave
Ste 2
Collinsville, CT 06019
Phone (860) 352-2463

Practitioners & affiliated clinicians

Practitioners 11

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": "1222819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1548411234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W MAIN ST",
            "address_2": "SUITE 204",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013681",
            "telephone_number": "860-679-0430",
            "fax_number": "860-679-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W MAIN ST",
            "address_2": "SUITE 204",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013681",
            "telephone_number": "860-679-0430",
            "fax_number": "860-679-0431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "61 Maple Ave",
            "address_2": "Ste. 2",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "CT",
            "postal_code": "060193058",
            "country_code": "US",
            "telephone_number": "860-352-2463",
            "fax_number": "860-352-8247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNA PHYSICAL THERAPY & GOLF MEDICINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-01",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "MAGNA",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-679-0430",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CT",
            "license": "004285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CT

Sources for this page

Verify at the official NPI Registry.