Individual provider Active NPI

Jeanette M Knill, PT

  • Physical Therapist
  • Green Bay, WI
National Provider Identifier
1104941772
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12077--24 Issued in WI
Practice address
720 S Vanburen St
Green Bay, WI 54230-3504
Phone
(920) 468-3444
Fax
(920) 432-6313
NPI assigned
Mar 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12077--24 WI Primary

Addresses

Primary practice location

720 S Vanburen St
Green Bay, WI 54230-3504

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

2641 Development Dr
Green Bay, WI 54311-4240
Phone (920) 338-6868

Other practice location 2

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-7822

Other practice location 3

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

Other practice location 4

725 S Webster Ave
Neuro Team
Green Bay, WI 54301-3500
Phone (920) 433-7995

Other practice location 5

704 S Webster Ave
Green Bay, WI 54301-3528
Phone (920) 433-3410

Other identifiers 1

IdentifierTypeStateIssuer
767190OtherILMEDICARE GROUP ID #

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
12077--24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc PastSince Dec 1, 2012 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595548800000",
    "number": "1104941772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S VANBUREN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "542303504",
            "telephone_number": "920-468-3444",
            "fax_number": "920-432-6313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2641 Development Dr",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543114240",
            "country_code": "US",
            "telephone_number": "920-338-6868",
            "fax_number": "920-338-6859",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-433-7822",
            "fax_number": "920-433-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 S Webster Ave",
            "address_2": "Neuro Team",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013500",
            "country_code": "US",
            "telephone_number": "920-433-7995",
            "fax_number": "920-433-3458",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "704 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013528",
            "country_code": "US",
            "telephone_number": "920-433-3410",
            "fax_number": "920-433-3419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNILL",
        "first_name": "JEANETTE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12077--24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID #",
            "identifier": "767190",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.