NPIMap

Individual provider Active NPI

Carmelo D Tenuta, PT

  • Physical Therapist
  • Kenosha, WI
National Provider Identifier
1144267550
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3494024 Issued in WI
Practice address
10222 74TH St
Suite 211
Kenosha, WI 53142-6810
Phone
(262) 925-5020
Fax
(262) 925-5021
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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 3494024 WI Primary

Addresses

Primary practice location

10222 74TH St
Suite 211
Kenosha, WI 53142-6810

Mailing address

3921 30TH Ave Ste C
Kenosha, WI 53144-1957
Phone (262) 925-5004

Other identifiers 2

IdentifierTypeStateIssuer
40178100MedicaidWI
11231652OtherCAQH

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

LicenseStateTypeSpecialty
3494WIMDChiropractor
3494024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kleinmeyer Physical Therapy and Rehab Specialists Physical Therapist PastSince Dec 20, 2004 Accepting new patients
Sports Physical Therapists of Cudahy LLC Physical Therapist PastSince Jun 7, 2017 Accepting new patients
Elite Physical Therapy and Rehab Specialists Physical Therapist PastSince Jan 6, 2005 Accepting new patients
Rice Lake Physical Therapy and Rehab Specialists Physical Therapist PastSince Apr 30, 2003 Accepting new patients
Sports Physical Therapists of Racine LLC Physical Therapist PastSince May 15, 2017 Accepting new patients
Kewanee Physical Therapy and Rehab Specialists LLC Physical Therapist PastSince Aug 1, 2004 Accepting new patients
Ellefson Therapy LTD Physical Therapist PastSince Oct 1, 2006 Accepting new patients
Livingwell N-Home Therapy LLC Physical Therapist PastSince May 1, 2018 Accepting new patients
Livingwell Home Medical Supplies Inc PastSince Jan 19, 2012 Accepting new patients
Center for Orthopedic and Rehabilitation Excellence LLC Physical Therapist PastSince Jun 13, 2005 Accepting new patients
Sports Physical Therapists of Fox Lake LLC Physical Therapist PastSince Dec 6, 2016 Accepting new patients

Organizations & group practices 11

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": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1144267550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 30TH AVE STE C",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441957",
            "telephone_number": "262-925-5004",
            "fax_number": "262-925-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10222 74TH ST",
            "address_2": "SUITE 211",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531426810",
            "telephone_number": "262-925-5020",
            "fax_number": "262-925-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENUTA",
        "first_name": "CARMELO",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3494024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40178100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11231652",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.

Verify at the official NPI Registry.