Healthcare Provider Details

I. General information

NPI: 1487723904
Provider Name (Legal Business Name): NEW ENGLAND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTHWESTERN DR
BRISTOL CT
06010-2847
US

IV. Provider business mailing address

30 NORTHWESTERN DR
BRISTOL CT
06010-2847
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-6378
  • Fax: 817-582-7526
Mailing address:
  • Phone: 860-583-6378
  • Fax: 817-582-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A DICHELLO
Title or Position: MANAGER
Credential:
Phone: 860-583-6378