Physiocare Physical Therapy and Sports Medicine, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

006963 Issued in CT

Legal business name

PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC

Doing business as

PhysioCare Physical Therapy and Sports Medicine

Practice address

11 Centre St
Suite 6&7
Salem, CT 06420-3844

Phone

(860) 608-2773

Fax

(860) 471-8388

NPI assigned

Jun 21, 2011

Last updated

Oct 2, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John H Bradford, PTNPI 1508971003

Title

Owner/Physical Therapist

Phone

(860) 608-2773

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• PhysioCare Physical Therapy and Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Physiocare Physical Therapy and Sports Medicine, LLC

  • Physical Therapist
  • East Lyme, CT
  • NPI 1649828005

  O20110818000310

  Same enrollment

Tax ID family

Physiocare Physical Therapy and Sports Medicine LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Physiocare Physical Therapy and Sports Medicine, LLC

  • Physical Therapist
  • East Lyme, CT
  • NPI 1649828005
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Physiocare Physical Therapy and Sports Medicine, LLC

  • Physical Therapist
  • East Lyme, CT
  • NPI 1649828005
  NPPES parent name

Practitioners 3

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.

• John Howard Bradford, MSPT

  • Physical Therapist
  • Salem, CT
  • NPI 1508971003
  Medicare reassignment NPD Authorized official
• Lauren Sisk Bradford, MSOTR/L

  • Occupational Therapist
  • Salem, CT
  • NPI 1619212941
  Medicare reassignment NPD
• Erin Russo

  • Pediatric Occupational Therapist
  • Salem, CT
  • NPI 1780353987
  NPD (past)

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1598051260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CENTRE ST",
            "address_2": "SUITE 6&7",
            "city": "SALEM",
            "state": "CT",
            "postal_code": "064203844",
            "telephone_number": "860-608-2773",
            "fax_number": "860-471-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CENTRE ST",
            "address_2": "SUITE 6&7",
            "city": "SALEM",
            "state": "CT",
            "postal_code": "064203844",
            "telephone_number": "860-608-2773",
            "fax_number": "860-471-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "860-608-2773",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "006963",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "009704",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": "004259",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004221868-02",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PhysioCare Physical Therapy and Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leena Bardwaj Menon, PHARMD
• Wendy Elizabeth Mikolinski, PHARMD
• Kylie Elizabeth Mikulka, RN
• Nasilele Musutu
• New Beginnings for Life, LLC
• Mary Ann S Pudimat, M.D.
• Paul Allen Pudimat, M.D.
• Joan D Rankowitz, RDH
• Nancy Rodgers
• Roseann Z George (Professional Hearing & Speech Aid Service)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; 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.