Individual provider Active NPI

Elizabeth Udovich, DPT

  • Neurology Physical Therapist
  • Brookfield, WI
National Provider Identifier
1144788381
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology Physical TherapistTaxonomy code 2251N0400X
Practice address
21700 Intertech Dr
Brookfield, WI 53045-5197
Phone
(262) 532-8628
NPI assigned
Mar 6, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physical Therapist 2251N0400X Primary

Addresses

Primary practice location

21700 Intertech Dr
Brookfield, WI 53045-5197

Mailing address

1707 Coldwater Creek Dr
Waukesha, WI 53188-8029

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190412000011 WI Practitioner - Physical Therapist in Private Practice 8921349317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1701 Fond Du Lac Ave
Kewaskum, WI 53040-9129
Phone (262) 626-4616

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11602WIMDDental Hygienist

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1144788381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 COLDWATER CREEK DR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531888029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21700 INTERTECH DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455197",
            "telephone_number": "262-532-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDOVICH",
        "first_name": "ELIZABETH",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.