Active NPI
Jennifer Ann Kehrberg, PTA
- Physical Therapy Assistant
- Hudson, WI
National Provider Identifier
1083702567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 684
- Practice address
- 2705 Enloe St
Hudson, WI 54016-8173 - Phone
- (715) 386-2128
- Fax
- (715) 386-6119
- NPI assigned
- Oct 10, 2006
- 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 Therapy Assistant | 225200000X | 684 | WI | Primary |
Addresses
Primary practice location
2705 Enloe St
Hudson, WI 54016-8173
Mailing address
11505 Valley Creek Rd
Woodbury, MN 55129-9491
Phone (651) 436-1691
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40249100 | 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 |
|---|---|---|---|
| 684 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1083702567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11505 VALLEY CREEK RD",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551299491",
"telephone_number": "651-436-1691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2705 ENLOE ST",
"city": "HUDSON",
"state": "WI",
"postal_code": "540168173",
"telephone_number": "715-386-2128",
"fax_number": "715-386-6119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEHRBERG",
"first_name": "JENNIFER",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "684",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40249100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.