NPIMap

Organization Active NPI

Wisconsin Orthopedic Physical Therapy

  • Physical Therapist
  • Wauwatosa, WI
National Provider Identifier
1376883835
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
WISCONSIN ORTHOPEDIC PHYSICAL THERAPY
Practice address
11702 W North Ave Ste B
Wauwatosa, WI 53226-2132
Phone
(414) 763-2941
NPI assigned
Feb 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Dr. Michael Roberts, P.T., D.P.T.NPI 1609154285
Title
Owner/Physical Therapist
Phone
(414) 763-2941

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary
Physical Therapy Clinic/Center 261QP2000X 11728-24 WI

Addresses

Primary practice location

11702 W North Ave Ste B
Wauwatosa, WI 53226-2132

Mailing address

11702 W North Ave Ste B
Wauwatosa, WI 53226-2132
Phone (414) 763-2941

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130520000018 WI Part B Supplier - Clinic/Group Practice 4486891017 Receives reassigned benefits from 11 practitioners
Practice locations: Wauwatosa, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Wisconsin Orthopedic Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11702 W North Ave
#B
Wauwatosa, WI 53226
Phone (262) 352-7868

11702 W North Ave
Wauwatosa, WI 53226

11702 W North Ave
#D
Wauwatosa, WI 53226

10125 W North Ave
Wauwatosa, WI 53226
Phone (414) 257-0676

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1376883835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11702 W NORTH AVE STE B",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262132",
            "telephone_number": "414-763-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11702 W NORTH AVE STE B",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262132",
            "telephone_number": "414-763-2941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN ORTHOPEDIC PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-21",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "414-763-2941",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "P.T., D.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WI",
            "license": "11728-24",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.