Great Lakes Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

GREAT LAKES PHYSICAL THERAPY, LLC

Practice address

3303 Superior Ave
Sheboygan, WI 53081-1861

Phone

(920) 208-3557

Fax

(920) 208-3527

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Joe E Moore, P.TNPI 1699852442

Title

Owner

Phone

(920) 208-3557

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joe E Moore, P.T.

  • Physical Therapist
  • Ozark, MO
  • NPI 1699852442
  NPD (past) Authorized official
• John Tyus O'Dell, P.T.

  • Physical Therapist
  • Oostburg, WI
  • NPI 1124105945
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124105028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811861",
            "telephone_number": "920-208-3557",
            "fax_number": "920-208-3527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811861",
            "telephone_number": "920-208-3557",
            "fax_number": "920-208-3527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-208-3557",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40420500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7725040",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Grados, PHARMD
• Sara J Grady, DDS
• Peter Grande
• Kathryn Grace Grapatin
• Great Lakes Clinic and Consultants
• Great Lakes Plastic Surgery SC
• Alex W Grech, DDS
• Charles Joseph Green, D.O.
• John Charles Green, MSSW
• Kathryn A Green, MD

• Physical Therapist in Sheboygan, WI
• Providers in Sheboygan, 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 22, 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.