Individual provider Active NPI

Phillip Michael Birdsall, D-PT

  • Physical Therapist
  • Green Bay, WI
National Provider Identifier
1376062661
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14009-24 Issued in WI
Practice address
704 S Webster Ave Ste 201
Green Bay, WI 54301-3528
Phone
(920) 433-3410
Fax
(920) 433-3419
NPI assigned
Sep 18, 2017
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 14009-24 WI Primary

Addresses

Primary practice location

704 S Webster Ave Ste 201
Green Bay, WI 54301-3528

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other practice location 1

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-7822

Other practice location 2

831 Parker Ave
Algoma, WI 54201-1808
Phone (920) 487-3676

Other practice location 3

311 N 3rd Ave
Sturgeon Bay, WI 54235-2401
Phone (920) 743-0255

Other practice location 4

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171011003714 WI Practitioner - Physical Therapist in Private Practice 4789959008 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14009-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Physical Therapist CurrentSince Sep 19, 2017 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Sep 19, 2017 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Jan 22, 2024 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Oconto Hospital & Medical Center, Inc. CurrentSince Jan 22, 2024 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc PastSince Jan 28, 2024 Accepting new patients
Bellin Psychiatric Center Inc. PastSince Jan 28, 2024 Accepting new patients

Locations

1510 Fremont St
Algoma, WI 54201
Phone (920) 487-3676

831 Parker Ave
Algoma, WI 54201
Phone (920) 487-3084

704 S Webster Ave
#201
Green Bay, WI 54301
Phone (920) 433-3410

704 S Webster Ave
Ste 201
Green Bay, WI 54301
Phone (920) 433-3410

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

311 N 3rd Ave
Sturgeon Bay, WI 54235
Phone (920) 433-6050

Interoperability endpoints

  • Direct secure messaging: pbirdsall182370@direct.thedacare.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1376062661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE STE 201",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013528",
            "telephone_number": "920-433-3410",
            "fax_number": "920-433-3419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-433-7822",
            "fax_number": "920-433-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "831 Parker Ave",
            "address_purpose": "LOCATION",
            "city": "Algoma",
            "state": "WI",
            "postal_code": "542011808",
            "country_code": "US",
            "telephone_number": "920-487-3676",
            "fax_number": "920-487-3084",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "311 N 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "542352401",
            "country_code": "US",
            "telephone_number": "920-743-0255",
            "fax_number": "920-743-6680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 Arbutus Ave",
            "address_purpose": "LOCATION",
            "city": "Oconto",
            "state": "WI",
            "postal_code": "541532004",
            "country_code": "US",
            "telephone_number": "920-835-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BIRDSALL",
        "first_name": "PHILLIP",
        "middle_name": "MICHAEL",
        "credential": "D-PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-18",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14009-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.