Active NPI
Betsy M Soukup, PTA
- Physical Therapy Assistant
- Winnebago, WI
National Provider Identifier
1376699314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 714019
- Practice address
- 725 Butler Avenue
Winnebago, WI 54985-0010 - Phone
- (920) 235-5100
- Fax
- (920) 233-7352
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 714019 | WI | Primary |
Addresses
Primary practice location
725 Butler Avenue
Winnebago, WI 54985-0010
Mailing address
1541 Oak St
Oshkosh, WI 54901
Phone (920) 231-5492
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40159400 | Medicaid | WI |
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 |
|---|---|---|---|
| 714019 | WI | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winnebago County | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Public Health or Welfare Agency
- Winnebago, WI
- NPI 1154318657
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376699314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1541 OAK ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "54901",
"telephone_number": "920-231-5492",
"fax_number": "920-233-7352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 BUTLER AVENUE",
"city": "WINNEBAGO",
"state": "WI",
"postal_code": "549850010",
"telephone_number": "920-235-5100",
"fax_number": "920-233-7352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUKUP",
"first_name": "BETSY",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "714019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40159400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winnebago, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.