Active NPI
Matthew Perchuk, P.T.
- Physical Therapist
- Wauwatosa, WI
National Provider Identifier
1346356565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4033-024
- Practice address
- 2626 N Wauwatosa Ave
Wauwatosa, WI 53213-1137 - Phone
- (414) 774-7794
- Fax
- (414) 607-6971
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- 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 | 4033-024 | WI | Primary |
Addresses
Primary practice location
2626 N Wauwatosa Ave
Wauwatosa, WI 53213-1137
Mailing address
101 W Brown Deer Rd
Bayside, WI 53217-2316
Phone (414) 446-4469
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40194700 | 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 |
|---|---|---|---|
| 4033-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346356565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 W BROWN DEER RD",
"city": "BAYSIDE",
"state": "WI",
"postal_code": "532172316",
"telephone_number": "414-446-4469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2626 N WAUWATOSA AVE",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532131137",
"telephone_number": "414-774-7794",
"fax_number": "414-607-6971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERCHUK",
"first_name": "MATTHEW",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4033-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40194700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, 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.