Physical Therapy of Southern Conneticut

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

PHYSICAL THERAPY OF SOUTHERN CONNETICUT

Practice address

917 Bridgeport Ave
Shelton, CT 06484-4679

Phone

(203) 735-8336

Fax

(203) 735-3704

NPI assigned

Nov 14, 2013

Organization subpart

Yes

Parent organization

PHYSICAL THERAPY OF SOUTHERN CONNECTICUTAs reported in NPPES

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

Authorized official

Name

Linda Maude, PT

Title

President

Phone

(203) 735-8336

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Child & Family Network Doing business as

Part of

Phys Therapy of Souther

Locations

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384387200000",
    "number": "1902236730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844679",
            "telephone_number": "203-735-8336",
            "fax_number": "203-735-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844679",
            "telephone_number": "203-735-8336",
            "fax_number": "203-735-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY OF SOUTHERN CONNETICUT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHYSICAL THERAPY OF SOUTHERN CONNECTICUT",
        "enumeration_date": "2013-11-14",
        "last_updated": "2013-11-14",
        "status": "A",
        "authorized_official_last_name": "MAUDE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-735-8336",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004398203",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Child & Family Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dinko Petrov, CRNA
• Stephanie Pettingle, APRN DNP
• Christopher Phillips, P.T.
• Kirstie Phillips, GRNA
• Jeanne Phung, LCSW
• Anthony Piaty
• Karen Sue Piciw, PA-C
• Terrin Pierce, PHARMD
• Lucyna Pietrucha, OT
• Pinke Eye Center, LLC

• Early Intervention Provider Agency in Shelton, CT
• Providers in Shelton, CT by specialty
• Early Intervention Provider Agency in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.