Individual provider Active NPI

Colleen Ann Wilkens, PT

  • Physical Therapist
  • Wauwatosa, WI
National Provider Identifier
1245279967
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6273-024 Issued in WI
Practice address
1510 Underwood Ave
Wauwatosa, WI 53213-2619
Phone
(262) 375-1075
Fax
(262) 375-4975
NPI assigned
Jun 6, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6273-024 WI Primary

Addresses

Primary practice location

1510 Underwood Ave
Wauwatosa, WI 53213-2619

Mailing address

10590 N Port Washington Rd
Mequon, WI 53092-5537
Phone (262) 375-1075

Other identifiers 1

IdentifierTypeStateIssuer
40318200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041215000967 WI Practitioner - Physical Therapist in Private Practice 5890752331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Body Renovation Physical Therapy SCGroup PAC ID 3779688403, 15 clinicians

Practice addresses (Care Compare)

20900 Swenson Dr
Suite 575
Waukesha, WI 53186-4040
Phone (262) 375-1075

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6273-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Sport & Spine, LLC Physical Therapist PastSince Nov 2, 2013 Accepting new patients
Body Renovation Health Services, S.C. Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1245279967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10590 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925537",
            "telephone_number": "262-375-1075",
            "fax_number": "262-375-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 UNDERWOOD AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132619",
            "telephone_number": "262-375-1075",
            "fax_number": "262-375-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKENS",
        "first_name": "COLLEEN",
        "middle_name": "ANN",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "6273-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40318200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.