Active NPI
Katie Lea Petersen, DPT
- Physical Therapist
- Bloomfield, CT
National Provider Identifier
1861883324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10387
- Practice address
- 510 Cottage Grove Rd
Bloomfield, CT 06002-3165 - Phone
- (860) 769-6690
- NPI assigned
- Feb 5, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10387 | CT | Primary |
Addresses
Primary practice location
510 Cottage Grove Rd
Bloomfield, CT 06002-3165
Mailing address
510 Cottage Grove Rd
Bloomfield, CT 06002-3165
Phone (860) 769-6690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423094400000",
"number": "1861883324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 COTTAGE GROVE RD",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060023165",
"telephone_number": "860-769-6690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 COTTAGE GROVE RD",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060023165",
"telephone_number": "860-769-6690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "KATIE",
"middle_name": "LEA",
"name_prefix": "Ms.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-05",
"last_updated": "2015-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "10387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.