Active NPI
Mary Elizabeth Ponzo, PT
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1346294345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2096
- Practice address
- 1155 N Mayfair Rd
Spine Care Clinic at Plank Road
Milwaukee, WI 53226-3421 - Phone
- (414) 955-7182
- NPI assigned
- May 22, 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 | 2096 | WI | Primary |
Addresses
Primary practice location
1155 N Mayfair Rd
Spine Care Clinic at Plank Road
Milwaukee, WI 53226-3421
Mailing address
1155 N Mayfair Rd
Spine Care Clinic at Plank Road
Milwaukee, WI 53226-3421
Phone (414) 955-7182
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346294345 | Medicaid | WI | |
| 008000215J | Other | HUMANA |
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 |
|---|---|---|---|
| 2096 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408665600000",
"number": "1346294345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1155 N MAYFAIR RD",
"address_2": "SPINE CARE CLINIC AT PLANK ROAD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263421",
"telephone_number": "414-955-7182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 N MAYFAIR RD",
"address_2": "SPINE CARE CLINIC AT PLANK ROAD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263421",
"telephone_number": "414-955-7182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONZO",
"first_name": "MARY ELIZABETH",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-22",
"last_updated": "2014-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "2096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1346294345",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "008000215J",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.