Healthcare Provider Details

I. General information

NPI: 1457214777
Provider Name (Legal Business Name): PROTEA PHYSICAL THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-29 HUDSON ST
BETHEL CT
06801-2030
US

IV. Provider business mailing address

14-29 HUDSON ST
BETHEL CT
06801-2030
US

V. Phone/Fax

Practice location:
  • Phone: 530-902-1571
  • Fax:
Mailing address:
  • Phone: 530-902-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROL-ANNE H HICKS
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 530-902-1571