Active NPI
Paul Robert Incha, PT
- Physical Therapist
- Fort Atkinson, WI
National Provider Identifier
1063431344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4640-024
- Practice address
- 1504 Madison Ave
Fort Atkinson, WI 53538 - Phone
- (920) 563-9357
- Fax
- (920) 568-6545
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- 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 | 4640-024 | WI | Primary |
Addresses
Primary practice location
1504 Madison Ave
Fort Atkinson, WI 53538
Mailing address
N 1541 Joyce Rd
Fort Atkinson, WI 53538
Phone (920) 563-9998
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36104200 | 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 |
|---|---|---|---|
| 4640-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278460800000",
"number": "1063431344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N 1541 JOYCE RD",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "53538",
"telephone_number": "920-563-9998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 MADISON AVE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "53538",
"telephone_number": "920-563-9357",
"fax_number": "920-568-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INCHA",
"first_name": "PAUL",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2010-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4640-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36104200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.