NPIMap

Organization Active NPI

Panacea Physical Therapy LLC

  • Rehabilitation Clinic/Center
  • Enfield, CT
National Provider Identifier
1851177265
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PANACEA PHYSICAL THERAPY LLC
Practice address
115 Elm St Ste 208
Enfield, CT 06082-3735
Phone
(860) 726-8163
NPI assigned
Sep 1, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Authorized official

Name
Ahmed Moustafa Sharaf, DPTNPI 1962147306
Title
Owner
Phone
(860) 726-8163

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

115 Elm St Ste 208
Enfield, CT 06082-3735

Mailing address

115 Elm St Ste 208
Enfield, CT 06082-3735
Phone (860) 726-8163

National Provider Directory

National Provider Directory
Tax ID family
Panacea Physical Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1693526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1851177265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ELM ST STE 208",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823735",
            "telephone_number": "860-726-8163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ELM ST STE 208",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823735",
            "telephone_number": "860-726-8163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANACEA PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-01",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "SHARAF",
        "authorized_official_first_name": "AHMED",
        "authorized_official_middle_name": "MOUSTAFA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-726-8163",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.