Greg Fernandez, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11288 Issued in WI

Practice address

2225 Wisconsin Ave Ste 100
Grafton, WI 53024-2608

Phone

(262) 474-0063

Fax

(262) 222-6281

NPI assigned

Aug 9, 2016

Last updated

Sep 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: greg.fernandez.p9@direct.athleticoltd.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  dba Athletico Physical Therapy

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028

  WI

  Medicare reassignment NPD
• Athletico LTD

  dba Athletico Physical Therapy

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD
• Muscle and Movement Therapy LLC

  • Chiropractor
  • Cedarburg, WI
  • NPI 1942662267
  NPD (past)

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1215481148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N69W5289 COLUMBIA RD",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122156",
            "telephone_number": "262-546-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 WISCONSIN AVE STE 100",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530242608",
            "telephone_number": "262-474-0063",
            "fax_number": "262-222-6281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1249 W Liebau Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Mequon",
            "state": "WI",
            "postal_code": "530923397",
            "country_code": "US",
            "telephone_number": "262-243-4161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "N69W5289 Columbia Rd",
            "address_purpose": "LOCATION",
            "city": "Cedarburg",
            "state": "WI",
            "postal_code": "530122156",
            "country_code": "US",
            "telephone_number": "262-546-4696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "GREG",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-09",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215481148",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Abigail R Flancher, PA-C
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• Physical Therapist in Grafton, WI
• Providers in Grafton, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.