1568549350 NPI number — NORDICARE PHYSICAL THERAPY, P.C.

Table of content: (NPI 1568549350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568549350 NPI number — NORDICARE PHYSICAL THERAPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORDICARE PHYSICAL THERAPY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568549350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 UPPER MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-364-9840
Provider Business Mailing Address Fax Number:
860-364-1859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 UPPER MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06069-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-364-9840
Provider Business Practice Location Address Fax Number:
860-364-1859
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAHL-BUSBY
Authorized Official First Name:
BENTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-364-9840

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A511350 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 552181 . This is a "ATENA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: Q34491 . This is a "EMPIRE BC / BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 43713 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50NORDICA CT 01 . This is a "ANTHEM BC / BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0123301 . This is a "ORTHONET / HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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