Individual provider Active NPI

Julie Dutton X, ATC

  • Athletic Trainer
  • Manchester, CT
National Provider Identifier
1902297609
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
000634 Issued in CT
Practice address
586 Middle Tpke E
Manchester, CT 06040-3730
Phone
(860) 645-3810
NPI assigned
Feb 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 000634 CT Primary

Addresses

Primary practice location

586 Middle Tpke E
Manchester, CT 06040-3730

Mailing address

11 Cindy Dr
Coventry, CT 06238-3469
Phone (860) 742-4428

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
000634CTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehabilitation Services Limited Partnership PastSince Jul 10, 2023 Accepting new patients
Integrated Rehabilitation Services, LLC PastSince Sep 3, 2002 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1902297609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CINDY DR",
            "city": "COVENTRY",
            "state": "CT",
            "postal_code": "062383469",
            "telephone_number": "860-742-4428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "586 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403730",
            "telephone_number": "860-645-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTTON",
        "first_name": "JULIE",
        "name_prefix": "Mrs.",
        "name_suffix": "X",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-17",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CT",
            "license": "000634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.

Verify at the official NPI Registry.