Douglas Radtke, LMT, BCTMB

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

4994-146 Issued in WI

Practice address

6233 Bankers Rd
Suite 12
Mount Pleasant, WI 53403-9700

Phone

(262) 358-6730

NPI assigned

Mar 1, 2017

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

State licenses

Practice roles

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.

• De Witt Physical Therapy & Wellness LLC

  • Physical Therapist
  • Mount Pleasant, WI
  • NPI 1538683982
  NPD (past)

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

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488326400000",
    "number": "1407396013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 BANKERS RD",
            "address_2": "SITTE 12",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039700",
            "telephone_number": "262-358-6730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6233 BANKERS RD",
            "address_2": "SUITE 12",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039700",
            "telephone_number": "262-358-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADTKE",
        "first_name": "DOUGLAS",
        "credential": "LMT, BCTMB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-01",
        "last_updated": "2017-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "WI",
            "license": "4994-146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Caton Putman, DPT
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• Jenna Radowski, MS ATR LCPC
• Marisa Raineri, PT, DPT
• Elizabeth Myunghee Ralston, APN
• Priya Ramdass, M.D
• Daniel Ramirez, DMD
• Sydnie Johanna Rampulla, APNP

• Prevention Professional in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Prevention Professional in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; 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.