Active NPI
Sue Lyn Condon, P.T.
- Physical Therapist
- Portage, WI
National Provider Identifier
1124213871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4741
- Practice address
- 2817 New Pinery Rd
Suite 103
Portage, WI 53901-9257 - Phone
- (608) 745-6211
- Fax
- (608) 745-6250
- NPI assigned
- Sep 6, 2007
- 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 | 4741 | WI | Primary |
Addresses
Primary practice location
2817 New Pinery Rd
Suite 103
Portage, WI 53901-9257
Mailing address
P.O. Box 387
2817 New Pinery Road, Suite 103
Portage, WI 53949
Phone (608) 745-6211
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40240700 | Medicaid | WI |
Other names 1
- Miss Sue Lyn Blazek
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 |
|---|---|---|---|
| 4741 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Divine Savior Healthcare | Past | Accepting new patients | |
| Divine Savior Healthcare | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Rural Acute Care Hospital
- Portage, WI
- NPI 1346543246
-
- Rural Acute Care Hospital
- Portage, WI
- NPI 1700189602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189036800000",
"number": "1124213871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 387",
"address_2": "2817 NEW PINERY ROAD, SUITE 103",
"city": "PORTAGE",
"state": "WI",
"postal_code": "53949",
"telephone_number": "608-745-6211",
"fax_number": "608-745-6250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 NEW PINERY RD",
"address_2": "SUITE 103",
"city": "PORTAGE",
"state": "WI",
"postal_code": "539019257",
"telephone_number": "608-745-6211",
"fax_number": "608-745-6250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONDON",
"first_name": "SUE",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-06",
"last_updated": "2007-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4741",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40240700",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUE",
"last_name": "BLAZEK",
"middle_name": "LYN",
"prefix": "MISS",
"credential": "P.T.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Portage, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.