Active NPI
Andrea R. Kysely, PTA
- Physical Therapy Clinic/Center
- Milwaukee, WI
National Provider Identifier
1245471424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 1558-019
- Practice address
- 2020 W Wells St
Milwaukee, WI 53233-2720 - Phone
- (414) 937-2128
- NPI assigned
- Mar 17, 2009
- Last updated
- Mar 17, 2009
- 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 Therapy Clinic/Center | 261QP2000X | 1558-019 | WI | Primary |
Addresses
Primary practice location
2020 W Wells St
Milwaukee, WI 53233-2720
Mailing address
2020 W Wells St
Milwaukee, WI 53233-2720
Phone (414) 937-2128
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558-019 | Medicaid | WI |
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 |
|---|---|---|---|
| 1558-019 | WI | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237248000000",
"number": "1245471424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 W WELLS ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532332720",
"telephone_number": "414-937-2128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 W WELLS ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532332720",
"telephone_number": "414-937-2128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KYSELY",
"first_name": "ANDREA",
"middle_name": "R.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-17",
"last_updated": "2009-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "WI",
"license": "1558-019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1558-019",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.