Extend Physical Therapy and Wellness

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

Legal business name

EXTEND PHYSICAL THERAPY AND WELLNESS

Practice address

1648 Kuiper LN
Mount Pleasant, WI 53406-4310

Phone

(262) 902-7881

NPI assigned

Jun 28, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Haley J Naegeli, PT, DPT

Title

Owner

Phone

(262) 902-7881

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1063082626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 KUIPER LN",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064310",
            "telephone_number": "262-902-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1648 KUIPER LN",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064310",
            "telephone_number": "262-902-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTEND PHYSICAL THERAPY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "NAEGELI",
        "authorized_official_first_name": "HALEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-902-7881",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Physical Therapist in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Geriatric Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.