Active NPI
Ryan Gorecki
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1104375682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1307124
- Practice address
- 2323 N Lake Dr
Milwaukee, WI 53211-4508 - Phone
- (414) 585-6884
- NPI assigned
- Sep 26, 2016
- Sex
- Male
- 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 Therapist | 225100000X | 1307124 | WI | Primary |
Addresses
Primary practice location
2323 N Lake Dr
Milwaukee, WI 53211-4508
Mailing address
2424 E Webster PL
109
Milwaukee, WI 53211-4183
Phone (630) 310-6198
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 |
|---|---|---|---|
| 1307124 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474848000000",
"number": "1104375682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2424 E WEBSTER PL",
"address_2": "109",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532114183",
"telephone_number": "630-310-6198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2323 N LAKE DR",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532114508",
"telephone_number": "414-585-6884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORECKI",
"first_name": "RYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-26",
"last_updated": "2016-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "1307124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.