Active NPI
Richard J. Deaver, P.T.
- Physical Therapist
- Three Lakes, WI
National Provider Identifier
1255508917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 963-024
- Practice address
- 7754 Braeger Rd
Three Lakes, WI 54562-9207 - Phone
- (715) 546-8026
- NPI assigned
- May 13, 2008
- Last updated
- May 13, 2008
- Sex
- Male
- 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 Therapist | 225100000X | 963-024 | WI | Primary |
Addresses
Primary practice location
7754 Braeger Rd
Three Lakes, WI 54562-9207
Mailing address
7754 1 Braeger Rd
Three Lakes, WI 54562-9207
Phone (715) 546-8026
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40100700 | 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 |
|---|---|---|---|
| 963-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1255508917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7754 1 BRAEGER RD",
"city": "THREE LAKES",
"state": "WI",
"postal_code": "545629207",
"telephone_number": "715-546-8026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7754 BRAEGER RD",
"city": "THREE LAKES",
"state": "WI",
"postal_code": "545629207",
"telephone_number": "715-546-8026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAVER",
"first_name": "RICHARD",
"middle_name": "J.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-13",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "963-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40100700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Three Lakes, WI
- Ascension Sacred Heart - St Mary's Hospitals, Inc. (Aspirus Three Lakes Clinic)
- Aspirus Medical Group, Inc. (Aspirus Three Lakes Clinic)
- Bethany Cervenansky
- Natalie Grace Craig, LMT, LPN
- DJH Inc (Three Lakes Pharmacy)
- Linden Fraser, RN
- Elizabeth A Kuhn, MSW, LCSW
- Lakes Dental Services, Inc.
- Linderud Apothecaries LLC (Three Lakes Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.