Colleen Davis

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14.007864 Issued in CT

Practice address

132 Cross Rd
Waterford, CT 06385-1204

Phone

(860) 572-6657

NPI assigned

May 19, 2019

Sex

Female

Sole proprietor

Yes

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

Specialty

Physical Therapist in Private Practice

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Goat Physical Therapy and Wellness LLCGroup PAC ID 5496193658, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Goat Physical Therapy and Wellness LLC

  • Physical Therapy Clinic/Center
  • Waterford, CT
  • NPI 1043828510

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1558224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558224000000",
    "number": "1770149353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 RAMBLEWOOD DR",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351640",
            "telephone_number": "860-572-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 CROSS RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063851204",
            "telephone_number": "860-572-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "COLLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-19",
        "last_updated": "2019-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "14.007864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate Cubelli, OT
• Tiarra Shafer Cupp, BCBA
• Curtin Motor Livery Service, Inc.
• Sue Ellen Daniels, LMFT
• Matthew Leon Danish, MD
• Jonathan Dean, LMFT
• Frank R. Dellacono, M.D.
• Brittany Desantis
• Anthony Devlin, HIS
• Mallory Rose Devona, MS, NCC, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2019; 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.