Elyse Landesberg, PT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

4635 Issued in CT

Practice address

40 Boston Post Rd
Waterford, CT 06385-2424

Phone

(860) 271-4900

NPI assigned

Aug 26, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1700499019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 ALEWIFE RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063853801",
            "telephone_number": "860-439-1323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 BOSTON POST RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063852424",
            "telephone_number": "860-271-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDESBERG",
        "first_name": "ELYSE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CT",
            "license": "4635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Physical Therapist in Waterford, CT
• Providers in Waterford, CT by specialty
• Pediatric Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.