Active NPI
Everardo Roque, PT, DPT
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1164106183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17914-24
- Practice address
- 2123 S 36TH St
Milwaukee, WI 53215-2308 - Phone
- (414) 378-4847
- NPI assigned
- Jun 12, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17914-24 | WI | Primary |
Addresses
Primary practice location
2123 S 36TH St
Milwaukee, WI 53215-2308
Mailing address
2745 S 45TH St
Milwaukee, WI 53219-3205
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787184000000",
"number": "1164106183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2745 S 45TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532193205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2123 S 36TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532152308",
"telephone_number": "414-378-4847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUE",
"first_name": "EVERARDO",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-12",
"last_updated": "2026-08-20",
"certification_date": "2026-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "17914-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.