NPIMap

Individual provider Active NPI

Elizabeth Marie Mortag, DPT

  • Physical Therapist
  • Jackson, WI
National Provider Identifier
1134522170
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12680-24 Issued in WI
Practice address
W225N16711 Cedar Park CT
Jackson, WI 53037-9222
Phone
(262) 677-1101
NPI assigned
Oct 5, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12680-24 WI Primary

Addresses

Primary practice location

W225N16711 Cedar Park CT
Jackson, WI 53037-9222

Mailing address

4320 N 142ND St
Brookfield, WI 53005-1142
Phone (309) 360-4162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241219003548 WI Practitioner - Physical Therapist in Private Practice 8921535584 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trinity Senior Services Care Partnering LLC 8 clinicians
Froedtert Andthe Medical College of Wisconsin Community Physicians Inc 1,265 clinicians

Practice addresses (Care Compare)

9525 W Burleigh St
Milwaukee, WI 53222-3563
Phone (414) 625-9905

W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060

W225N16711 Cedar Park CT
Jackson, WI 53037-9222
Phone (262) 677-1101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12680WIMDClinical Social Worker
12680-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Dec 9, 2024 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Dec 9, 2024 Accepting new patients
Trinity Senior Services Care Partnering LLC Physical Therapist CurrentSince Oct 7, 2025 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

W225N16711 Cedar Park Ct
Jackson, WI 53037
Phone (262) 323-9257

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1412467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1134522170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 N 142ND ST",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530051142",
            "telephone_number": "309-360-4162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W225N16711 CEDAR PARK CT",
            "city": "JACKSON",
            "state": "WI",
            "postal_code": "530379222",
            "telephone_number": "262-677-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTAG",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-05",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12680-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.