NPIMap

Organization Active NPI

Profectus Physical Therapy LLC

  • Physical Therapist
  • Kenosha, WI
National Provider Identifier
1245776590
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11955-024 Issued in WI
Legal business name
PROFECTUS PHYSICAL THERAPY LLC
Practice address
6123 Green Bay Rd Ste 140
Kenosha, WI 53142-2927
Phone
(262) 653-9208
NPI assigned
Jan 10, 2017
Last updated
Jan 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Authorized official

Name
Mr. Darren Louis Nelson, DPTNPI 1427303049
Title
Owner
Phone
(262) 551-7946

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11955-024 WI Primary

Addresses

Primary practice location

6123 Green Bay Rd Ste 140
Kenosha, WI 53142-2927

Mailing address

6123 Green Bay Rd Ste 140
Kenosha, WI 53142-2927

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1245776590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD STE 140",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD STE 140",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-653-9208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFECTUS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-10",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-551-7946",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11955-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; 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.