Kelly Lee Straus-Diedrick, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4444 Issued in WI

Practice address

725 Butler Ave
Winnebago, WI 54985

Phone

(920) 235-5100

Fax

(980) 233-7352

NPI assigned

May 25, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Winnebago County

  • Public Health or Welfare Agency
  • Winnebago, WI
  • NPI 1154318657
  NPD (past)

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083825608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W387 WEILER RD",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "54130",
            "telephone_number": "920-766-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 BUTLER AVE",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "54985",
            "telephone_number": "920-235-5100",
            "fax_number": "980-233-7352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STRAUS-DIEDRICK",
        "first_name": "KELLY",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dara B. Sitter, R.PH., PHD.
• Betsy M Soukup, PTA
• Clifford K Stephens, PH.D
• Katie Marie Stinson, LCSW
• Jacob Strange, PA-C
• Sylvester A Szadkowski, M.D.
• Julie Ann Thiel, BS PHARM, BCPP
• Laura Jo Thompson, RPH
• Cherish Torrence, APNP
• John Edward Vickman, M.D

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.