Active NPI
Susan Dee Nulty, LPTA
- Physical Therapy Assistant
- Milwaukee, WI
National Provider Identifier
1114193885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 595019
- Practice address
- 6735 W Bradley Rd
Milwaukee, WI 53223-3325 - Phone
- (414) 354-3300
- Fax
- (414) 354-7419
- NPI assigned
- May 2, 2008
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 595019 | WI | Primary |
Addresses
Primary practice location
6735 W Bradley Rd
Milwaukee, WI 53223-3325
Mailing address
6735 W Bradley Rd
Milwaukee, WI 53223-3325
Phone (414) 354-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40044400 | Medicaid | WI |
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 |
|---|---|---|---|
| 595019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209686400000",
"number": "1114193885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6735 W BRADLEY RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532233325",
"telephone_number": "414-354-3300",
"fax_number": "414-354-7419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6735 W BRADLEY RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532233325",
"telephone_number": "414-354-3300",
"fax_number": "414-354-7419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NULTY",
"first_name": "SUSAN",
"middle_name": "DEE",
"name_prefix": "Ms.",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-02",
"last_updated": "2008-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "595019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40044400",
"state": "WI"
}
],
"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 May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.