Individual provider Active NPI

Angela Marie Domnitz, PT

  • Orthopedic Physical Therapist
  • Mequon, WI
National Provider Identifier
1164976155
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
10437 Issued in WI
Practice address
11363 N. Port Washington Road
Mequon, WI 53092
Phone
(262) 833-2060
Fax
(262) 833-2061
NPI assigned
Aug 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 10437 WI Primary

Addresses

Primary practice location

11363 N. Port Washington Road
Mequon, WI 53092

Mailing address

33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258
Phone (586) 350-2644

Other practice location 1

5333 N Port Washington Rd Ste B
Glendale, WI 53217-4914
Phone (414) 716-1770

Other names 1

  • Angela Kurtz Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050505001097 WI Practitioner - Physical Therapist in Private Practice 4688652951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Team Rehabilitation Services LLCGroup PAC ID 2264479518, 569 clinicians

Practice addresses (Care Compare)

11363 N Port Washington Rd
Mequon, WI 53092-3411
Phone (586) 350-2644

Merit-based Incentive Payment System (MIPS)

Final score
81.73 of 100Reported as group
Quality
87.86
Improvement activities
40
Cost
61.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10437WIMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Team Rehabilitation Services, LLC CurrentSince Oct 22, 2021 Accepting new patients
Team Rehabilitation Services, LLC Orthopedic CurrentSince Oct 22, 2021 Accepting new patients
Center for Physical Therapy & Sports Medicine, PC Orthopedic Past Accepting new patients
Chesterfield Physical Therapy Inc. Past Accepting new patients
May Physical Therapy Services LLC Orthopedic Past Accepting new patients

Locations

33900 Harper Ave
Ste 104
Clinton Twp, MI 48035
Phone (586) 416-9100

5333 N Port Washington Rd
Ste B
Glendale, WI 53217
Phone (414) 716-1770

N81W15014 Appleton Ave
Menomonee Falls, WI 53051
Phone (262) 714-7040

11363 N Port Washington Rd
Mequon, WI 53092
Phone (262) 833-2060

Organizations & group practices 5

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": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1164976155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2644",
            "fax_number": "586-541-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11363 N. PORT WASHINGTON ROAD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "53092",
            "telephone_number": "262-833-2060",
            "fax_number": "262-833-2061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5333 N Port Washington Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "WI",
            "postal_code": "532174914",
            "country_code": "US",
            "telephone_number": "414-716-1770",
            "fax_number": "414-716-1772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMNITZ",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-08",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WI",
            "license": "10437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "KURTZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; 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.