Individual provider Active NPI

Jack Kolvig, PT, DPT

  • Physical Therapist
  • Southbury, CT
National Provider Identifier
1710857883
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15177 Issued in CT
Practice address
100 Main St N
Southbury, CT 06488-3840
Phone
(959) 209-4318
NPI assigned
Nov 5, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15177 CT Primary

Addresses

Primary practice location

100 Main St N
Southbury, CT 06488-3840

Mailing address

73 Peach Farm Rd
Oxford, CT 06478-1824
Phone (203) 513-1409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251126000004 CT Practitioner - Physical Therapist in Private Practice 2163914185 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Connect Physical Therapy LLCGroup PAC ID 2163792771, 16 clinicians

Practice addresses (Care Compare)

777 Echo Lake Rd
Suite 1
Watertown, CT 06795-6617
Phone (959) 209-4318

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15177CTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Connect Physical Therapy, LLC Physical Therapist CurrentSince Nov 5, 2025 Accepting new patients

Locations

100 Main St N
Southbury, CT 06488
Phone (203) 262-4559

777 Echo Lake Rd
Ste 1
Watertown, CT 06795
Phone (959) 209-4318

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1762300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1710857883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 PEACH FARM RD",
            "city": "OXFORD",
            "state": "CT",
            "postal_code": "064781824",
            "telephone_number": "203-513-1409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAIN ST N",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064883840",
            "telephone_number": "959-209-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLVIG",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-05",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "15177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.