Jared Matthew Dubois, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

400 Deronda St
Amery, WI 54001-1404

Phone

(715) 268-8171

NPI assigned

Jul 26, 2021

Last updated

Jul 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Willow Ridge Healthcare Facilities, LLC

  dba Willow Ridge

  • Skilled Nursing Facility
  • Amery, WI
  • NPI 1275689903
  NPD (past)

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1386317592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2894 GREEN VIEW DR",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547030621",
            "telephone_number": "715-820-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 DERONDA ST",
            "city": "AMERY",
            "state": "WI",
            "postal_code": "540011404",
            "telephone_number": "715-268-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOIS",
        "first_name": "JARED",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorant Divald, M.D.
• Amy E. Dooley, MD
• David Paul Doroff, D.D.S.
• Douglas D Podoll DDS DC
• Mark R Druffner, MD
• Kody T Dudgeon
• Evan Eid
• Paul F. Elbing, MD
• Zachary Fucik Fahrenkrug, ATC, LAT, CSCS
• Family Eye Inc

• Physical Therapy Assistant in Amery, WI
• Providers in Amery, 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 Jul 26, 2021; 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.