Courtney Wack, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10680 Issued in WI

Practice address

4602 Eastpark Blvd.
First Floor Rehab Mail Code Ac10
Madison, WI 53718

Phone

(608) 440-6440

NPI assigned

Nov 13, 2014

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

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advanced Pain Management SC

  • Pain Medicine Physician
  • Greenfield, WI
  • NPI 1770506669
  NPD
• Advanced Pain Management, SC

  • Durable Medical Equipment & Medical Supplies
  • Evansville, IN
  • NPI 1669832655
  NPD

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

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1295131522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 HUNTSVILLE RDG",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535904209",
            "telephone_number": "414-241-7674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 EASTPARK BLVD.",
            "address_2": "FIRST FLOOR REHAB MAIL CODE AC10",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53718",
            "telephone_number": "608-440-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACK",
        "first_name": "COURTNEY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-13",
        "last_updated": "2021-04-08",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline S Wabiszewski, LCSW
• Blake Wachholz, LPC-IT
• Jennifer L Wachholz, PA-C
• Lisa A Wachholz, CNM
• Rebecca A Wachowiak
• Emily Wacker
• Joel M. Wacker, M.D.
• Kathleen M Wackerle, NP
• Brian J Wackwitz, D.D.S.
• Donald L Wackwitz, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.