Active NPI
Dayne John Marlenga, PTA
- Physical Therapy Assistant
- Menasha, WI
National Provider Identifier
1184282485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2919-19
- Practice address
- 1700 Midway Rd
Menasha, WI 54952-1230 - Phone
- (920) 739-0111
- NPI assigned
- May 31, 2019
- 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 Therapy Assistant | 225200000X | 2919-19 | WI | Primary |
Addresses
Primary practice location
1700 Midway Rd
Menasha, WI 54952-1230
Mailing address
W9347 County Road J
Catawba, WI 54515-9741
Phone (715) 820-1225
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2919-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1184282485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W9347 COUNTY ROAD J",
"city": "CATAWBA",
"state": "WI",
"postal_code": "545159741",
"telephone_number": "715-820-1225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 MIDWAY RD",
"city": "MENASHA",
"state": "WI",
"postal_code": "549521230",
"telephone_number": "920-739-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARLENGA",
"first_name": "DAYNE",
"middle_name": "JOHN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-31",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "2919-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menasha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.