NPIMap

Organization Active NPI

Freedom Physical Therapy Services SC

  • Physical Therapist
  • Fox Point, WI
National Provider Identifier
1063406544
Registry record updated Oct 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FREEDOM PHYSICAL THERAPY SERVICES SC
Practice address
6908 N Santa Monica Blvd
Fox Point, WI 53217-3942
Phone
(414) 352-2082
Fax
(414) 352-5279
NPI assigned
Sep 9, 2005
Last updated
Oct 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2012

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

Authorized official

Name
Mr. Peter J Stathas, PTNPI 1013930650
Title
President
Phone
(414) 352-2082

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X WI Primary

Addresses

Primary practice location

6908 N Santa Monica Blvd
Fox Point, WI 53217-3942

Mailing address

6908 N Santa Monica Blvd
Fox Point, WI 53217-3942
Phone (414) 352-2082

Other identifiers 1

IdentifierTypeStateIssuer
40418500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000955 WI Part B Supplier - Clinic/Group Practice 8224938113 Receives reassigned benefits from 38 practitioners
Practice locations: Brookfield, WI; Fox Point, WI; Grafton, WI; Mukwonago, WI

National Provider Directory

National Provider Directory

Locations

14625 W Capitol Dr
Ste 200
Brookfield, WI 53005
Phone (262) 439-9506

17495 W Capitol Dr
Ste I
Brookfield, WI 53045
Phone (262) 790-9800

1235 Dakota Dr
Ste L
Grafton, WI 53024
Phone (262) 376-2085

6908 N Santa Monica Blvd
Milwaukee, WI 53217
Phone (414) 352-2082

111 Atkinson St
Ste 2
Mukwonago, WI 53149
Phone (262) 363-3268

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1063406544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6908 N SANTA MONICA BLVD",
            "city": "FOX POINT",
            "state": "WI",
            "postal_code": "532173942",
            "telephone_number": "414-352-2082",
            "fax_number": "414-352-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6908 N SANTA MONICA BLVD",
            "city": "FOX POINT",
            "state": "WI",
            "postal_code": "532173942",
            "telephone_number": "414-352-2082",
            "fax_number": "414-352-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEDOM PHYSICAL THERAPY SERVICES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "STATHAS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-352-2082",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40418500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fox Point, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.