Active NPI
Bethany G. Petrella, P.T. , M.S.P.T.
- Physical Therapist
- Putnam, CT
National Provider Identifier
1629132337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 004177
- Practice address
- 333 Pomfret St
Putnam, CT 06260-1852 - Phone
- (860) 928-9444
- Fax
- (860) 928-4811
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- 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 | 004177 | CT | Primary |
Addresses
Primary practice location
333 Pomfret St
Putnam, CT 06260-1852
Mailing address
76 Tinkerville Rd
Willington, CT 06279-1426
Phone (860) 429-0403
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004177 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629132337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 TINKERVILLE RD",
"city": "WILLINGTON",
"state": "CT",
"postal_code": "062791426",
"telephone_number": "860-429-0403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 POMFRET ST",
"city": "PUTNAM",
"state": "CT",
"postal_code": "062601852",
"telephone_number": "860-928-9444",
"fax_number": "860-928-4811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRELLA",
"first_name": "BETHANY",
"middle_name": "G.",
"name_prefix": "Ms.",
"credential": "P.T. , M.S.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "004177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Putnam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.