Molly Jean Fermanich, PTA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4098-19 Issued in WI

Practice address

4810 Barbican Ave
Weston, WI 54476-4186

Phone

(715) 393-0400

NPI assigned

Nov 21, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1306611140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W9209 COUNTY ROAD F",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544099116",
            "telephone_number": "715-219-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 BARBICAN AVE",
            "city": "WESTON",
            "state": "WI",
            "postal_code": "544764186",
            "telephone_number": "715-393-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERMANICH",
        "first_name": "MOLLY",
        "middle_name": "JEAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-21",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "4098-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Weston, WI
• Providers in Weston, WI by specialty
• Physical Medicine & Rehabilitation Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; 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.