NPIMap

Organization Active NPI

New Life Physical Therapy & Sports Medicine Baraboo, LLC

  • Physical Therapist
  • Baraboo, WI
National Provider Identifier
1154599082
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
APPLIED FOR Issued in WI
Legal business name
NEW LIFE PHYSICAL THERAPY & SPORTS MEDICINE BARABOO, LLC
Practice address
840 US Highway 12
Suite 3
Baraboo, WI 53913-9277
Phone
(608) 356-2334
Fax
(608) 356-2636
NPI assigned
Feb 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Authorized official

Name
Mr. Bryan Cummings, PT
Title
Owner
Phone
(608) 356-2334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X APPLIED FOR WI Primary

Addresses

Primary practice location

840 US Highway 12
Suite 3
Baraboo, WI 53913-9277

Mailing address

840 US Highway 12
Suite 3
Baraboo, WI 53913-9277
Phone (608) 356-2334

Other identifiers 1

IdentifierTypeStateIssuer
APPLIED FOR ALLOtherWIALL APPLIED FOR

National Provider Directory

National Provider Directory

Locations

626 14th St
Baraboo, WI 53913
Phone (608) 356-2334

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423094400000",
    "number": "1154599082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 US HIGHWAY 12",
            "address_2": "SUITE 3",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539139277",
            "telephone_number": "608-356-2334",
            "fax_number": "608-356-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 US HIGHWAY 12",
            "address_2": "SUITE 3",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539139277",
            "telephone_number": "608-356-2334",
            "fax_number": "608-356-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIFE PHYSICAL THERAPY & SPORTS MEDICINE BARABOO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2015-02-05",
        "status": "A",
        "authorized_official_last_name": "CUMMINGS",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-356-2334",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "APPLIED FOR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL APPLIED FOR",
            "identifier": "APPLIED FOR ALL",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baraboo, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; 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.