Thomas Michael Jones, PT – Physical Therapist

Key facts

NPI: 1376696989
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: 3452-024 (WI)
Practice address: 1461 W Main St
Whitewater, WI 53190-1568
Phone: (262) 473-5599
Fax: (262) 473-8522
NPI assigned: Jan 18, 2007
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
3452-024	WI	MD	Physical Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	3452-024	WI	Yes

Addresses

Primary practice location

1461 W Main St
Whitewater, WI 53190-1568

Mailing address

7 Margaret Ave
Fort Atkinson, WI 53538-9391
Phone (920) 563-1084

Other identifiers

Identifier	Type	State	Issuer
36104800	Medicaid	WI
3452-024	Other	WI	STATE LICENSE PT

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376696989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MARGARET AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535389391",
            "telephone_number": "920-563-1084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901568",
            "telephone_number": "262-473-5599",
            "fax_number": "262-473-8522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "THOMAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3452-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36104800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE PT",
            "identifier": "3452-024",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitewater, WI

All providers in Whitewater, WI · Physical Therapist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.