Amanda Kanack, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

2906 S 20TH St
Milwaukee, WI 53215-3732

Phone

(414) 672-1353

NPI assigned

Sep 10, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• NSH Mercy LLC

  • Skilled Nursing Facility
  • Milwaukee, WI
  • NPI 1134647928
  NPD (past)
• Sixteenth Street Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
  • NPI 1821517681
  NPD (past)

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1376026062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 778789",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606778789",
            "telephone_number": "414-672-1353",
            "fax_number": "262-408-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2906 S 20TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153732",
            "telephone_number": "414-672-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANACK",
        "first_name": "AMANDA",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376026062",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latha N Kampalath, MD
• Jack Kampf
• Gary Michael Kampman, RPH
• Farzad Kamrani, MD
• Hema Kamthamneni, M.D.
• Joel Kananen
• Priyanka Kancherla, RPH
• Prem Kandiah, MD
• Cheryl Kandler-Krutina, RN
• Gwen M Kandula, AU.D, MBA

• Physical Therapy Assistant in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.