Active NPI
Jody Weber, DPT
- Physical Therapist
- Beaver Dam, WI
National Provider Identifier
1124119375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4447
- Practice address
- 705 S University Avenue
Ste 150
Beaver Dam, WI 53916 - Phone
- (920) 885-2663
- Fax
- (920) 885-2466
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 4447 | WI | Primary |
Addresses
Primary practice location
705 S University Avenue
Ste 150
Beaver Dam, WI 53916
Mailing address
705 S University Avenue
Ste 150
Beaver Dam, WI 53916
Phone (920) 885-2663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40205900 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4447 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Excel Orthopedics, LTD. | Past | 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.
-
- Orthopaedic Surgery Physician
- Beaver Dam, WI
- NPI 1366554487
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364947200000",
"number": "1124119375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 S UNIVERSITY AVENUE",
"address_2": "STE 150",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "53916",
"telephone_number": "920-885-2663",
"fax_number": "920-885-2466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 S UNIVERSITY AVENUE",
"address_2": "STE 150",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "53916",
"telephone_number": "920-885-2663",
"fax_number": "920-885-2466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEBER",
"first_name": "JODY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2013-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4447",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40205900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaver Dam, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.