Physiocare Physical Therapy and Sports Medicine, LLC
Organization Active NPI Physical Therapist · East Lyme, CT
NPI 1649828005 · NPPES record last updated Aug 29, 2019
Key facts
- NPI
- 1649828005
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
- Practice address
- 131 Boston Post Rd
East Lyme, CT 06333-1605 - Phone
- (860) 949-2561
- NPI assigned
- Aug 29, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Authorized official
- Name
- John Howard Bradford, DPT
- Title
- Owner
- Phone
- (860) 949-2561
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 4
-
John Howard Bradford, MSPT
-
Lauren Sisk Bradford, MSOTR/L
-
Joshua Cappello, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110818000310 | CT | Part B Supplier - Clinic/Group Practice | 7012186596 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salem, CT; East Lyme, CT |
National Provider Directory
- Tax ID family
- Physiocare Physical Therapy and Sports Medicine LLC
- Part of
- Physiocare Physical Therapy and Sports Medicine LLC
Locations
11 Centre St
Ste 7
Salem, CT 06420
Phone (860) 949-2561
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X |
Addresses
Primary practice location
131 Boston Post Rd
East Lyme, CT 06333-1605
Mailing address
11 Centre St Ste 7
Salem, CT 06420-3845
Phone (860) 949-2561
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jb@physiocareptsm.com | Direct |
Other providers in East Lyme, CT
- Sung Park
- Maureen Pavelski
- Peaceful Paths Counseling
- Alyssa Perez
- Peter J. Famiglietti, M.D.
- Brian Mark Pochal
- Hong Qi
- R&W Non-Emergency Medical Transport LLC
- Nancy A Randall
- Sylvia Rasie
All providers in East Lyme, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.