Organization Active NPI

Shoreline Physical Therapy and Sports Medicine LLC

  • Physical Therapy Clinic/Center
  • Milford, CT
National Provider Identifier
1962551655
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1245 Issued in CT
Legal business name
SHORELINE PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Practice address
60 Commerce Park
Milford, CT 06460-3506
Phone
(203) 876-7316
Fax
(203) 876-0041
NPI assigned
Jan 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Karen A Dobosz, P.T
Title
President
Phone
(203) 876-7316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 1245 CT Primary

Addresses

Primary practice location

60 Commerce Park
Milford, CT 06460-3506

Mailing address

60 Commerce Park
Milford, CT 06460-3506
Phone (203) 876-7316

Other identifiers 2

IdentifierTypeStateIssuer
080001245CT03OtherCTBLUE CROSS BLUE SHIELD
35501OtherCTCIGNA

National Provider Directory

National Provider Directory

Locations

60 Commerce Park
Milford, CT 06460
Phone (203) 876-7316

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": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962551655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PARK",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603506",
            "telephone_number": "203-876-7316",
            "fax_number": "203-876-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PARK",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603506",
            "telephone_number": "203-876-7316",
            "fax_number": "203-876-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE PHYSICAL THERAPY AND SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOBOSZ",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-876-7316",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "P.T"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CT",
            "license": "1245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "080001245CT03",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "35501",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.