Active NPI
Peggy A Bevernitz, P.T.
- Physical Therapist
- Keshena, WI
National Provider Identifier
1285675496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1804-024
- Practice address
- W3275 Wolf River Road
Keshena, WI 54135 - Phone
- (715) 799-3361
- Fax
- (715) 799-3099
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 1804-024 | WI | Primary |
Addresses
Primary practice location
W3275 Wolf River Road
Keshena, WI 54135
Mailing address
PO Box 970
Keshena, WI 54135-0970
Phone (715) 799-3361
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40086900 | 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 |
|---|---|---|---|
| 1804-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1285675496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 970",
"city": "KESHENA",
"state": "WI",
"postal_code": "541350970",
"telephone_number": "715-799-3361",
"fax_number": "715-799-3099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W3275 WOLF RIVER ROAD",
"city": "KESHENA",
"state": "WI",
"postal_code": "54135",
"telephone_number": "715-799-3361",
"fax_number": "715-799-3099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVERNITZ",
"first_name": "PEGGY",
"middle_name": "A",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "1804-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40086900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Keshena, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.