Active NPI
Phonso Smith
- Physical Therapist
- Mount Pleasant, WI
National Provider Identifier
1366824864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13110-24
- Practice address
- 1300 S Green Bay Rd
Mount Pleasant, WI 53406-4469 - Phone
- (262) 898-3930
- Fax
- (262) 898-3933
- NPI assigned
- Jun 22, 2015
- Sex
- Male
- 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 Therapist | 225100000X | 13110-24 | WI | Primary |
Addresses
Primary practice location
1300 S Green Bay Rd
Mount Pleasant, WI 53406-4469
Mailing address
1300 S Green Bay Rd
Mount Pleasant, WI 53406-4469
Phone (262) 898-3930
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 |
|---|---|---|---|
| 13110-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434931200000",
"number": "1366824864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 S GREEN BAY RD",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534064469",
"telephone_number": "262-898-3930",
"fax_number": "262-898-3933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 S GREEN BAY RD",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534064469",
"telephone_number": "262-898-3930",
"fax_number": "262-898-3933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "PHONSO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-22",
"last_updated": "2015-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "13110-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.