Edward V Van Dewater, MPT CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9822-024 Issued in WI

Practice address

6222 Washington Ave
Mount Pleasant, WI 53406-3948

Phone

(262) 884-6418

Fax

(262) 884-6489

NPI assigned

Dec 5, 2006

Last updated

Nov 21, 2021By the provider in NPPES

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Spine and SportGroup PAC ID 6800895855, 5 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Spine and Sport

  dba Advanced Spine and Sport Rehabilitation

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1033277553
  Medicare reassignment Care Compare group NPD
• Commonwealth Medical Group, LLC

  • Internal Medicine Physician
  • West Allis, WI
  • NPI 1477500361

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637452800000",
    "number": "1083772529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6222 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534063948",
            "telephone_number": "262-884-6418",
            "fax_number": "262-884-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6222 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534063948",
            "telephone_number": "262-884-6418",
            "fax_number": "262-884-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DEWATER",
        "first_name": "EDWARD",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "MPT CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-11-21",
        "certification_date": "2021-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "9822-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40407400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "9822-024",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Kathryn Umhoefer, M.D.
• Jamie Lynn Vacek
• Jacob Valabov, DPM
• David N Van de Water, DPT
• Thomas D Van de Water, MPT
• Carolyn Louise Van Straten, OTR/L
• Amber Van Voorst, RN, CRNA
• Emily Fumo Vanderhoef
• Natasha N Vandervere, RN
• Janet Vannatta

• Physical Therapist in Mount Pleasant, WI
• Providers in Mount Pleasant, 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 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.