Jaclyn Dias, PT, DPT, GCS
Individual provider Active NPI Physical Therapist · Bridgeport, CT
NPI 1730633116 · NPPES record last updated Jan 12, 2021
Key facts
- NPI
- 1730633116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 011016 (CT)
- Practice address
- 4200 Park Ave
Bridgeport, CT 06604-1049 - Phone
- (203) 365-6443
- Fax
- (203) 396-1046
- NPI assigned
- Aug 15, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161006001588 | CT | Practitioner - Physical Therapist in Private Practice | 3577851575 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 011016 | CT | Yes |
Addresses
Primary practice location
4200 Park Ave
Bridgeport, CT 06604-1049
Mailing address
4200 Park Ave
Bridgeport, CT 06604-1049
Phone (203) 365-6443
Other providers in Bridgeport, CT
- Pierre F. Dhaiti
- Binaya Dhakal
- Monica Dhillon
- Dialyze Direct CT LLC
- Diamond Home Care Agency LLC
- Julia Marie Dias
- Gail Diaz
- Nikkia Diaz
- Steven Diaz Sr.
- Samantha Dibenedetto
All providers in Bridgeport, 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 Jan 12, 2021. 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.