Amy Beth Flock, PTA
Individual provider Active NPI Physical Therapy Assistant · Mukwonago, WI
NPI 1215966908 · NPPES record last updated Nov 27, 2024
Key facts
- NPI
- 1215966908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 348-019 (WI)
- Practice address
- 955 Main St Ste CD
Mukwonago, WI 53149-1752 - Phone
- (262) 662-9760
- Fax
- (262) 662-9761
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 348-019 | WI | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hammer Rehab & Fitness, LTD | Current |
Accepting new patients |
Locations
W231S7680 Big Bend Dr
Big Bend, WI 53103
Phone (262) 662-9760
955 Main St
Ste Cd
Mukwonago, WI 53149
Phone (262) 662-9760
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 348-019 | WI | Yes |
Addresses
Primary practice location
955 Main St Ste CD
Mukwonago, WI 53149-1752
Mailing address
29632 Clover LN
Waterford, WI 53185-5004
Phone (414) 640-0335
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40437000 | Medicaid | WI |
Other providers in Mukwonago, WI
- Steven C. Fehr
- Colette L Feldman
- Jacqueline L. Feuerer
- Nicole Fischer
- Lauren Elizabeth Fleming
- Rita Foster
- Four a'S Helping Lives
- Jennifer L Friehe
- Kyla Galles
- Jeffrey D Gentile
All providers in Mukwonago, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.