Nina Carlson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13147 Issued in WI

Practice address

2300 Western Ave
Manitowoc, WI 54220-3712

Phone

(920) 320-3100

Fax

(920) 684-3194

NPI assigned

Aug 5, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nina Carlson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Froedtert Manitowoc Medical Group, LLC

  dba Froedtert Northeast Medical Group

  • Multi-Specialty Clinic/Center
  • Manitowoc, WI
  • NPI 1437829975
  NPD (past)

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

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1245616911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-3100",
            "fax_number": "920-684-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-3100",
            "fax_number": "920-684-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "NINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-05",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700998697",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NINA",
            "last_name": "CARLSON",
            "credential": "PT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Matthew Campbell, MD
• Patricia J Cantagallo, MD
• Julie Capello, OTA
• Mark J Capriolo, MD
• Geralyn Ann Carducci, DO
• Theresa Carlson
• Jeremiah Carolfi, PHARMD
• Debra Kay Carstens, P.T.A.
• Sierra Marie Carter
• September Lee Casteel, LCSW; LICSW

• Physical Therapist in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.