Active NPI
Diane Radtke, PT
- Physical Therapist
- Green Bay, WI
National Provider Identifier
1295749208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4184
- Practice address
- 760 Pilgrim Way
Green Bay, WI 54304-5263 - Phone
- (920) 496-4700
- Fax
- (920) 496-4705
- NPI assigned
- Jul 27, 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 | 4184 | WI | Primary |
Addresses
Primary practice location
760 Pilgrim Way
Green Bay, WI 54304-5263
Mailing address
PO Box 19070
Prevea Health
Green Bay, WI 54307-9070
Phone (920) 496-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40206000 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4184 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295749208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19070",
"address_2": "PREVEA HEALTH",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079070",
"telephone_number": "920-496-4700",
"fax_number": "920-496-4705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 PILGRIM WAY",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045263",
"telephone_number": "920-496-4700",
"fax_number": "920-496-4705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADTKE",
"first_name": "DIANE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40206000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.