Active NPI
Charlie Ravanelli
- Physical Therapist
- Appleton, WI
National Provider Identifier
1174454078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17759-24
- Practice address
- 1506 S. Oneida Street
Appleton, WI 54915 - Phone
- (920) 738-2000
- NPI assigned
- May 28, 2026
- 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 | 17759-24 | WI | Primary |
Addresses
Primary practice location
1506 S. Oneida Street
Appleton, WI 54915
Mailing address
12211 N Willow Glenn CT
Mequon, WI 53092-3331
Phone (262) 395-0085
Other practice location 1
131 E. Washington St., Suite 1A
Appleton, WI 54911
Phone (920) 852-5300
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17759-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779926400000",
"number": "1174454078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12211 N WILLOW GLENN CT",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923331",
"telephone_number": "262-395-0085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1506 S. ONEIDA STREET",
"city": "APPLETON",
"state": "WI",
"postal_code": "54915",
"telephone_number": "920-738-2000"
}
],
"practiceLocations": [
{
"address_1": "131 E. Washington St., Suite 1A",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "54911",
"country_code": "US",
"telephone_number": "920-852-5300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RAVANELLI",
"first_name": "CHARLIE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-28",
"last_updated": "2026-05-28",
"certification_date": "2026-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "17759-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.