Jennie A Gosselin, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13403 Issued in CT

Practice address

101 N Plains Industrial Rd
Wallingford, CT 06492-2360

Phone

(203) 265-0018

Fax

(203) 265-4368

NPI assigned

Nov 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Connecticut, Inc.

  • Physical Therapist
  • Old Greenwich, CT
  • NPI 1265799365
  Medicare reassignment NPD

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1679230296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N PLAINS INDUSTRIAL RD",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922360",
            "telephone_number": "203-265-0018",
            "fax_number": "203-265-4368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSSELIN",
        "first_name": "JENNIE",
        "middle_name": "A",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "13403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystina A Gonsalves, LCSW
• Mel A Gonzales, PT, DPT
• Barry Chester Gordon, LMFT
• Phyllis Lee Gordon, LMFT
• Pamela Jean Gorman
• Ashley Ryan Grace, LMSW
• Carrie Elizabeth Grassi, NP
• Gray Ventures, LLC
• Joshua Green
• Katey Elizabeth Green, APRN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; 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.