Active NPI
Jennifer L Schreiter Pethan, PT
- Physical Therapist
- Chilton, WI
National Provider Identifier
1033367149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9805-024
- Practice address
- 614 Memorial Drive
Chilton, WI 53014 - Phone
- (920) 849-7508
- Fax
- (920) 849-1811
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9805-024 | WI | Primary |
Addresses
Primary practice location
614 Memorial Drive
Chilton, WI 53014
Mailing address
614 Memorial Drive
Chilton, WI 53014
Phone (920) 849-7508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40388700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9805-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422316800000",
"number": "1033367149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 MEMORIAL DRIVE",
"city": "CHILTON",
"state": "WI",
"postal_code": "53014",
"telephone_number": "920-849-7508",
"fax_number": "920-849-1811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "614 MEMORIAL DRIVE",
"city": "CHILTON",
"state": "WI",
"postal_code": "53014",
"telephone_number": "920-849-7508",
"fax_number": "920-849-1811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHREITER PETHAN",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2015-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "9805-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40388700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chilton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.