NPIMap

Organization Active NPI

Clear Lake Physical Therapy and Rehab Specialists LLC

  • Physical Therapist
  • Clear Lake, WI
National Provider Identifier
1083845754
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CLEAR LAKE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
Practice address
417 3Rd Ave
Clear Lake, WI 54005
Phone
(715) 263-4103
Fax
(866) 245-8064
NPI assigned
Jul 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Authorized official

Name
Emily J MonsonNPI 1225042013
Title
Owner/PT
Phone
(715) 263-4103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

417 3Rd Ave
Clear Lake, WI 54005

Mailing address

PO Box 147
Clear Lake, WI 54005-0147
Phone (715) 986-4103

Other practice location 1

100 Becker St
Turtle Lake, WI 54889-9205
Phone (715) 986-4103

Other practice location 2

930 Elden Ave
Amery, WI 54001-1448
Phone (715) 263-4103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091027000797 WI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0749327526 Receives reassigned benefits from 4 practitioners
Practice locations: Turtle Lake, WI; Prairie Farm, WI; Amery, WI; Clear Lake, WI

National Provider Directory

National Provider Directory

Locations

930 Elden Ave
Amery, WI 54001
Phone (715) 268-5103

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616544000000",
    "number": "1083845754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 147",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540050147",
            "telephone_number": "715-986-4103",
            "fax_number": "715-986-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 3RD AVE",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "54005",
            "telephone_number": "715-263-4103",
            "fax_number": "866-245-8064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Becker St",
            "address_purpose": "LOCATION",
            "city": "Turtle Lake",
            "state": "WI",
            "postal_code": "548899205",
            "country_code": "US",
            "telephone_number": "715-986-4103",
            "fax_number": "715-986-4128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 Elden Ave",
            "address_purpose": "LOCATION",
            "city": "Amery",
            "state": "WI",
            "postal_code": "540011448",
            "country_code": "US",
            "telephone_number": "715-263-4103",
            "fax_number": "715-263-4110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLEAR LAKE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-29",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A",
        "authorized_official_last_name": "MONSON",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PT",
        "authorized_official_telephone_number": "715-263-4103"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clear Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; 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.