Tina Neisius, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

762-19 Issued in WI

Practice address

709 Meadow Park Dr
Clinton, WI 53525-9777

Phone

(608) 676-2202

NPI assigned

Apr 16, 2013

Sex

Female

Sole proprietor

No

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

State licenses

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1376986786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5417 E BUSS RD",
            "city": "CLINTON",
            "state": "WI",
            "postal_code": "535258805",
            "telephone_number": "608-365-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 MEADOW PARK DR",
            "city": "CLINTON",
            "state": "WI",
            "postal_code": "535259777",
            "telephone_number": "608-676-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEISIUS",
        "first_name": "TINA",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-16",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "762-19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSURE",
            "identifier": "762-19",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian A Hamann, DDS
• Treasa Hendrickson
• Brooke Johansen, RN
• Heather Lynn Kluck, PA-C
• Alex Marchillo
• Jessica Nenneman
• Tejesh N Patel, MD
• Shuler Dental Office, S.C.
• Andrew Frank Shuler, DDS
• Susan M Spears, R.N.

• Physical Therapy Assistant in Clinton, WI
• Providers in Clinton, 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 Apr 16, 2013; 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.