Courtney Disterhaft, DPT
Individual provider Active NPI Physical Therapist · Berlin, WI
NPI 1003439720 · NPPES record last updated May 28, 2020
Key facts
- NPI
- 1003439720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 225 Memorial Dr
Berlin, WI 54923-1243 - Phone
- (920) 361-1313
- NPI assigned
- May 28, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220131001422 | WI | Practitioner - Physical Therapist in Private Practice | 6406249234 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Valley Physical Therapy & Wellness Clinic, Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
909 S Washburn St
Oshkosh, WI 54904
Phone (920) 235-8966
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Yes |
Addresses
Primary practice location
225 Memorial Dr
Berlin, WI 54923-1243
Mailing address
W13239 Penny LN
Ripon, WI 54971-9586
Phone (920) 896-1996
Other providers in Berlin, WI
- County of Green Lake
- Victoria Cross
- Maria Graziella Cruz-Apolinario
- Mary Swieskowski Cummins
- Rebecca Davis
- Tiffani L Driessen
- Erin K Eferem
- Jill Margaret Egbert
- Gary A. Eggert
- Emily T Engelke
All providers in Berlin, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.