Active NPI
Susan Uilani Versino, PT
- Physical Therapist
- Libertyville, IL
National Provider Identifier
1134367121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.002310
- Practice address
- 610 Peterson Rd
Libertyville, IL 60048-1014 - Phone
- (847) 367-6100
- NPI assigned
- Jan 28, 2009
- Last updated
- Jan 28, 2009
- 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 | 070.002310 | IL | Primary |
Addresses
Primary practice location
610 Peterson Rd
Libertyville, IL 60048-1014
Mailing address
610 Peterson Rd
Libertyville, IL 60048-1014
Phone (847) 367-6100
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 |
|---|---|---|---|
| 070.002310 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Libertyville Manor Extended Care Facility, Inc. | Physical Therapist | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Skilled Nursing Facility
- Libertyville, IL
- NPI 1952390585
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233100800000",
"number": "1134367121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 PETERSON RD",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600481014",
"telephone_number": "847-367-6100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 PETERSON RD",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600481014",
"telephone_number": "847-367-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERSINO",
"first_name": "SUSAN",
"middle_name": "UILANI",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-28",
"last_updated": "2009-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.002310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.