Provider Demographics
NPI:1568549350
Name:NORDICARE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:NORDICARE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL-BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-364-9840
Mailing Address - Street 1:22 UPPER MAIN STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069
Mailing Address - Country:US
Mailing Address - Phone:860-364-9840
Mailing Address - Fax:860-364-1859
Practice Address - Street 1:22 UPPER MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2083
Practice Address - Country:US
Practice Address - Phone:860-364-9840
Practice Address - Fax:860-364-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA511350OtherOXFORD
CT552181OtherATENA
NYQ34491OtherEMPIRE BC / BS
NY43713OtherMVP
CT50NORDICA CT 01OtherANTHEM BC / BS
CT0123301OtherORTHONET / HEALTHNET
DECO1465Medicare ID - Type UnspecifiedCLINIC #