# PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649828005
- **Legal business name:** PHYSIOCARE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
- **Authorized official:** JOHN HOWARD BRADFORD DPT (OWNER)
- **Authorized official phone:** (860) 949-2561

## Contact information

- **Practice address:** 131 BOSTON POST RD, EAST LYME, CT 06333-1605
- **Practice address phone:** (860) 949-2561
- **Mailing address:** 11 CENTRE ST STE 7, SALEM, CT 06420-3845
- **Mailing address phone:** (860) 949-2561
- **Mailing address fax:** (860) 471-8388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 08/29/2019
- **Last updated:** 08/29/2019