Michael A Brodzeller, B.S.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1252 Issued in WI

Practice address

5595 County Road Z
West Bend, WI 53095-9224

Phone

(262) 306-2150

Fax

(262) 306-2151

NPI assigned

Jun 20, 2005

Last updated

Nov 3, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225670400000",
    "number": "1194720789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-306-2150",
            "fax_number": "262-306-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-306-2150",
            "fax_number": "262-306-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODZELLER",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "B.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2008-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7742485",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40041900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in West Bend, WI
• Providers in West Bend, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; 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.