Jacquelyn Ann Kubiak, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4777 Issued in WI

Practice address

4111 W Mitchell St
Milwaukee, WI 53215-1748

Phone

(414) 643-3860

NPI assigned

Dec 2, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aurora Advanced Healthcare, Inc.

  • Family Medicine Physician
  • Milwaukee, WI
  • NPI 1265629133
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment NPD
• Lakeshore Medical Clinic, LLC

  • Family Medicine Physician
  • Saint Francis, WI
  • NPI 1003861188

  Physical Therapist

  Medicare reassignment NPD
• Aurora Advanced Healthcare Inc

  • Durable Medical Equipment & Medical Supplies
  • Summit, WI
  • NPI 1477186633
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Lakeshore Medical Clinic LTD

  • Family Medicine Physician
  • South Milwaukee, WI
  • NPI 1174851893
  NPD

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1083157473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 W MITCHELL ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532151748",
            "telephone_number": "414-643-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 W MITCHELL ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532151748",
            "telephone_number": "414-643-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBIAK",
        "first_name": "JACQUELYN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-02",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100070642",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkubiak25573@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4111 W Mitchell St",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532151748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4111 W Mitchell St",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532151748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brandon Ksobiech
• KTK Investment Services LLC
• Lai Kuang, M.D.
• Amy Kuba
• Nicole Kubeck, AGACNP-BC
• Lauren Marie Kubik, LCSW
• Jilan Kubusek, PHARRMD, BCPS
• Marina Elizabeth Kuchar
• Genevieve S Kuchinsky, NP
• Sara Lynn Kucik, CTRS

• Physical Therapist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; 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.