Active NPI
Patricia Jean Theabo
- Physical Therapy Assistant
- Fond Du Lac, WI
National Provider Identifier
1366677379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 720-019
- Practice address
- 845 South Main Street
Suite 120
Fond Du Lac, WI 54935-6116 - Phone
- (920) 322-0447
- Fax
- (920) 322-1362
- NPI assigned
- May 19, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 720-019 | WI | Primary |
Addresses
Primary practice location
845 South Main Street
Suite 120
Fond Du Lac, WI 54935-6116
Mailing address
845 South Main Street
Suite 120
Fond Du Lac, WI 54935-6116
Phone (920) 322-0447
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 720-019 | WI | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Taylored Rehab, LLC | Past | Accepting new patients | |
| Rehab Arisces Home Health Services | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Home Health Agency
- Fond Du Lac, WI
- NPI 1740626332
-
- Physical Therapy Clinic/Center
- Fond Du Lac, WI
- NPI 1356485791
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264982400000",
"number": "1366677379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "845 SOUTH MAIN STREET",
"address_2": "SUITE 120",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549356116",
"telephone_number": "920-322-0447",
"fax_number": "920-322-1362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 SOUTH MAIN STREET",
"address_2": "SUITE 120",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549356116",
"telephone_number": "920-322-0447",
"fax_number": "920-322-1362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEABO",
"first_name": "PATRICIA",
"middle_name": "JEAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-19",
"last_updated": "2010-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "720-019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.