Healthcare Provider Details

I. General information

NPI: 1225105448
Provider Name (Legal Business Name): PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 NORWICH AVE
COLCHESTER CT
06415-1274
US

IV. Provider business mailing address

171 NORWICH AVE
COLCHESTER CT
06415-1274
US

V. Phone/Fax

Practice location:
  • Phone: 860-537-3014
  • Fax: 860-537-1420
Mailing address:
  • Phone: 860-537-3014
  • Fax: 860-537-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER DIPASQUALE
Title or Position: PRESIDENT
Credential: PT
Phone: 860-537-3014