Eclectic Physical Therapy LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

005735 Issued in CT

Legal business name

ECLECTIC PHYSICAL THERAPY LLC

Practice address

2889 Fairfield Ave
Bridgeport, CT 06605-3211

Phone

(203) 913-6978

NPI assigned

Mar 21, 2013

Last updated

May 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Lee Iannucci, PTNPI 1831128834

Title

Physical Therapist, Owner

Phone

(203) 913-6978

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Lee Iannucci, PT

  • Orthopedic Physical Therapist
  • Bridegport, CT
  • NPI 1831128834
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400198400000",
    "number": "1730421397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 DRIFTWOOD LN",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066111861",
            "telephone_number": "203-913-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2889 FAIRFIELD AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066053211",
            "telephone_number": "203-913-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECLECTIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-21",
        "last_updated": "2014-05-16",
        "status": "A",
        "authorized_official_last_name": "IANNUCCI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "203-913-6978",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CT",
            "license": "005735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Artem Dyatlov, M.D.
• Michael Dziubina, PA-C
• Helen Dzujna, P.A.C
• Florence Ebbecke
• Melissa Ebdon, RD
• Jane Neikirk Edgell
• Kristin L. Edgerton
• Edward M Lane MD PC
• Kimberly Edwards, PT
• Nicole Danielle Edwards, D.D.S.

• Clinic/Center in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; 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.