Active NPI
Sally Syzdek
- Physical Therapist
- West Bend, WI
National Provider Identifier
1215786389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15491-25
- Practice address
- 1751 Barton Ave
West Bend, WI 53090-1905 - Phone
- (414) 736-7516
- NPI assigned
- May 13, 2024
- Last updated
- May 13, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 15491-25 | WI | Primary |
Addresses
Primary practice location
1751 Barton Ave
West Bend, WI 53090-1905
Mailing address
1539 Ravine Forest Dr
West Bend, WI 53090-1055
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 |
|---|---|---|---|
| 15491-25 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715558400000",
"number": "1215786389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1539 RAVINE FOREST DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530901055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1751 BARTON AVE",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530901905",
"telephone_number": "414-736-7516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SYZDEK",
"first_name": "SALLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-13",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "WI",
"license": "15491-25",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.