Organization Active NPI

Sports Physical Therapists, LLC

  • Physical Therapist
  • Kenosha, WI
National Provider Identifier
1104299940
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPORTS PHYSICAL THERAPISTS, LLC
Practice address
10222 74TH St
Suite 211
Kenosha, WI 53142-6810
Phone
(262) 925-5020
Fax
(262) 925-5021
NPI assigned
Nov 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Authorized official

Name
Joseph A Tenuta, MBA
Title
Senior Vice President/Coo
Phone
(262) 925-5003

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

10222 74TH St
Suite 211
Kenosha, WI 53142-6810

Mailing address

3921 30TH Ave Ste C
Kenosha, WI 53144-1957
Phone (262) 925-5004

National Provider Directory

National Provider Directory

Locations

301 E Main St
Ste 103
Twin Lakes, WI 53181
Phone (262) 925-5240

NPI Registry JSON

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

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1104299940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 30TH AVE STE C",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441957",
            "telephone_number": "262-925-5004",
            "fax_number": "262-925-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10222 74TH ST",
            "address_2": "SUITE 211",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531426810",
            "telephone_number": "262-925-5020",
            "fax_number": "262-925-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS PHYSICAL THERAPISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-02",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "TENUTA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "262-925-5003",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; 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.