Active NPI
Kaye Anne Tradewell, PTA
- Physical Therapy Assistant
- Racine, WI
National Provider Identifier
1104042472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 982-019
- Practice address
- 6101 16TH St
Racine, WI 53406-4467 - Phone
- (262) 898-2777
- Fax
- (262) 619-1547
- NPI assigned
- Apr 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 982-019 | WI | Primary |
Addresses
Primary practice location
6101 16TH St
Racine, WI 53406-4467
Mailing address
6101 16TH St
Racine, WI 53406-4467
Phone (262) 898-2777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104042472 | 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 |
|---|---|---|---|
| 982-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389484800000",
"number": "1104042472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6101 16TH ST",
"city": "RACINE",
"state": "WI",
"postal_code": "534064467",
"telephone_number": "262-898-2777",
"fax_number": "262-619-1547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6101 16TH ST",
"city": "RACINE",
"state": "WI",
"postal_code": "534064467",
"telephone_number": "262-898-2777",
"fax_number": "262-619-1547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRADEWELL",
"first_name": "KAYE",
"middle_name": "ANNE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2014-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "982-019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104042472",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.