Fastback Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FASTBACK PHYSICAL THERAPY LLC

Practice address

3333 S Sunnyslope Rd Ste 103B
New Berlin, WI 53151-4504

Phone

(262) 853-8452

NPI assigned

Oct 30, 2018

Last updated

Aug 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michele Weninger

Title

Credentialing Specialist

Phone

(248) 601-9207

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patrick S Barron

  • Physical Therapist
  • New Berlin, WI
  • NPI 1326071200
  Medicare reassignment NPD
• Alexandria L Dollhopf, PT, DPT

  • Physical Therapist
  • Oak Creek, WI
  • NPI 1932884277
  Medicare reassignment NPD
• Angela Rose Giangiulio

  • Speech-Language Pathologist
  • Juneau, WI
  • NPI 1386212447
  Medicare reassignment NPD
• Ashley Elizabeth Ziegler

  • Physical Therapist
  • Greenfield, WI
  • NPI 1972200186
  Medicare reassignment NPD
• Joshua Gonzaga

  • Physical Therapist
  • New Berlin, WI
  • NPI 1538087754
  NPD

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1104393982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1773 STAR BATT DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483093708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S SUNNYSLOPE RD STE 103B",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531514504",
            "telephone_number": "262-853-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FASTBACK PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-30",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "WENINGER",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "248-601-9207"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Viane Faily, MD
• Faith in Action Homes, LLC
• Mary Jane Farley, LCSW
• Kathryn Rae Farwell, M.D.
• Roseann Fasi
• Audrey Brooke Fawcett, PA
• Scott D. Fenske, M.D.
• Angela Ferri, DDS
• Christine Marie Finne, P.T.
• Deanne Fischer, PT

• Physical Therapist in New Berlin, WI
• Providers in New Berlin, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.