Active NPI
Jacquelyn P Petropoulos, PTA
- Physical Therapy Assistant
- Wauwatosa, WI
National Provider Identifier
1124526934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 221
- Practice address
- 2500 N Mayfair Rd
Wauwatosa, WI 53226-1409 - Phone
- (414) 443-1269
- Fax
- (414) 443-1285
- NPI assigned
- Jan 26, 2018
- 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 Therapy Assistant | 225200000X | 221 | WI | Primary |
Addresses
Primary practice location
2500 N Mayfair Rd
Wauwatosa, WI 53226-1409
Mailing address
2500 N Mayfair Rd
Wauwatosa, WI 53226-1409
Phone (414) 443-1269
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 |
|---|---|---|---|
| 221 | WI | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572998400000",
"number": "1124526934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532261409",
"telephone_number": "414-443-1269",
"fax_number": "414-443-1285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532261409",
"telephone_number": "414-443-1269",
"fax_number": "414-443-1285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROPOULOS",
"first_name": "JACQUELYN",
"middle_name": "P",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-26",
"last_updated": "2019-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, WI
- Kimberly Anne Peterson, M.A. CCC-SLP
- Molly G Peterson, BS, IBCLC, RLC
- Tracy M Peterson, NURSE PRACTIONER
- Janelle Marie Petinga, ANP-BC
- Katelin Petrin, CPNP
- Michael Anthony Pezewski, PHARMD
- Margaret Pfeiffer, M.S., R.D., C.L.S.
- Lisa Maria Phillips, FNP
- Alice M Phipps, CNM, NP
- Hinhpalom A Phouybanhdyt, M.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.