Active NPI
Sports Physical Therapists, LLC
- Physical Therapist
- Kenosha, WI
National Provider Identifier
1104299940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 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 DirectoryLocations
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.