Individual provider Active NPI

Suzanne Lundy, PT

  • Physical Therapist
  • Glendale, WI
National Provider Identifier
1134524879
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5426-24 Issued in WI
Practice address
5333 N Port Washington Rd Ste B
Glendale, WI 53217-4914
Phone
(414) 716-1770
Fax
(414) 716-1772
NPI assigned
Oct 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15011 NC
Physical Therapist 225100000X 5426-24 WI Primary

Addresses

Primary practice location

5333 N Port Washington Rd Ste B
Glendale, WI 53217-4914

Mailing address

33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258

Other identifiers 1

IdentifierTypeStateIssuer
15011OtherNCNC LICENSE

Other names 1

  • Suzanne Miller Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250320001864 WI Practitioner - Physical Therapist in Private Practice 8527382175 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15011NCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Team Rehabilitation Services, LLC Physical Therapist CurrentSince Jan 10, 2025 Accepting new patients
Team Rehabilitation Services, LLC Physical Therapist CurrentSince Jan 10, 2025 Accepting new patients

Locations

33900 Harper Ave
Ste 104
Clinton Twp, MI 48035
Phone (586) 416-9100

5333 N Port Washington Rd
Ste B
Glendale, WI 53217
Phone (414) 716-1770

11363 N Port Washington Rd
Mequon, WI 53092
Phone (262) 833-2060

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.

NPI Registry JSON

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1134524879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 N PORT WASHINGTON RD STE B",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174914",
            "telephone_number": "414-716-1770",
            "fax_number": "414-716-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDY",
        "first_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-23",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "15011",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "5426-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "15011",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZANNE",
            "last_name": "MILLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.