Active NPI
Michelle Suzanne Braithwaite, PT
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1134647845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14545-24
- Practice address
- 2900 W Oklahoma Ave Ste 518
Milwaukee, WI 53215-4330 - Phone
- (414) 649-3250
- NPI assigned
- Sep 1, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10400509-2401 | UT | |
| Physical Therapist | 225100000X | 14545-24 | WI | Primary |
Addresses
Primary practice location
2900 W Oklahoma Ave Ste 518
Milwaukee, WI 53215-4330
Mailing address
1300 S Green Bay Rd Ste 205
Mount Pleasant, WI 53406-4469
Phone (262) 898-3930
Other practice location 1
2512 W Lincoln Ave
Milwaukee, WI 53215-2575
Phone (414) 383-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100088859 | Medicaid | WI |
Other names 1
- Michelle Suzanne Wangrow
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 |
|---|---|---|---|
| 14545-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605484800000",
"number": "1134647845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 S GREEN BAY RD STE 205",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534064469",
"telephone_number": "262-898-3930",
"fax_number": "262-898-3933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 W OKLAHOMA AVE STE 518",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532154330",
"telephone_number": "414-649-3250"
}
],
"practiceLocations": [
{
"address_1": "2512 W Lincoln Ave",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532152575",
"country_code": "US",
"telephone_number": "414-383-4600",
"fax_number": "414-383-4609",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRAITHWAITE",
"first_name": "MICHELLE",
"middle_name": "SUZANNE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-01",
"last_updated": "2020-11-16",
"certification_date": "2020-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "10400509-2401",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14545-24",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100088859",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELLE",
"last_name": "WANGROW",
"middle_name": "SUZANNE",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.