MEDICARE: PROTEA PHYSICAL THERAPY & WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1457214777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTEA PHYSICAL THERAPY & WELLNESS LLC

Provider Business Mailing Address
First Line	:	14 DEPOT PL APT 1
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2575
Country	:	US
Telephone Number	:	203-286-3075
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 DEPOT PL APT 1
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2575
Country	:	US
Telephone Number	:	530-902-1571
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	CAROL-ANNE H HICKS
Credential	:	PT, DPT
Telephone Number	:	203-286-3075

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	01/17/2026

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