Active NPI
Michelle Lee Janke, P.T.
- Physical Therapist
- West Bend, WI
National Provider Identifier
1407906936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3940-024
- Practice address
- 5505 Highway Z
West Bend, WI 53095-9224 - Phone
- (262) 306-2691
- Fax
- (262) 306-2689
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | 3940-024 | WI | Primary |
Addresses
Primary practice location
5505 Highway Z
West Bend, WI 53095-9224
Mailing address
3211 Mediterranean Ave
West Bend, WI 53090-8426
Other practice location 1
3200 Pleasant Valley Rd
West Bend, WI 53095-9274
Phone (262) 677-6816
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20125800 | Medicaid | WI |
Other names 1
- Mrs. Michelle Lee Jurena
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 |
|---|---|---|---|
| 3940-024 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benevolent Corporation Cedar Community | 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.
-
- Pharmacy
- West Bend, WI
- NPI 1154321602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1407906936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3211 MEDITERRANEAN AVE",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530908426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5505 HIGHWAY Z",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959224",
"telephone_number": "262-306-2691",
"fax_number": "262-306-2689"
}
],
"practiceLocations": [
{
"address_1": "3200 Pleasant Valley Rd",
"address_purpose": "LOCATION",
"city": "West Bend",
"state": "WI",
"postal_code": "530959274",
"country_code": "US",
"telephone_number": "262-677-6816",
"fax_number": "262-677-6801",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JANKE",
"first_name": "MICHELLE",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "3940-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20125800",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELLE",
"last_name": "JURENA",
"middle_name": "LEE",
"prefix": "MRS.",
"credential": "P.T.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.