Frank C Fantazzi, PT DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1770-024 Issued in WI

Practice address

1532 S Green Bay Rd Ste 200
Mt Pleasant, WI 53406-4410

Phone

(262) 321-0240

Fax

(262) 321-0242

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Chad Novasic PT LTD

  • Physical Therapist
  • Racine, WI
  • NPI 1578679890
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1154349090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1532 S GREEN BAY RD",
            "address_2": "STE 200",
            "city": "MT PLEASANT",
            "state": "WI",
            "postal_code": "534064410",
            "telephone_number": "262-321-0240",
            "fax_number": "262-321-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 S GREEN BAY RD STE 200",
            "city": "MT PLEASANT",
            "state": "WI",
            "postal_code": "534064410",
            "telephone_number": "262-321-0240",
            "fax_number": "262-321-0242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2915 W Layton Ave",
            "address_purpose": "LOCATION",
            "city": "Greenfield",
            "state": "WI",
            "postal_code": "532212626",
            "country_code": "US",
            "telephone_number": "414-282-7810",
            "fax_number": "414-282-9120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 Pilgrim Pkwy Ste L8",
            "address_purpose": "LOCATION",
            "city": "Elm Grove",
            "state": "WI",
            "postal_code": "531222064",
            "country_code": "US",
            "telephone_number": "262-796-2850",
            "fax_number": "262-796-2851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANTAZZI",
        "first_name": "FRANK",
        "middle_name": "C",
        "credential": "PT DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1770-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40039400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Mt Pleasant, WI
• Providers in Mt Pleasant, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.