Five Corners Physical Therapy S.C.

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1504-154 Issued in WI

Legal business name

FIVE CORNERS PHYSICAL THERAPY S.C.

Practice address

7269 State Road 60
Suite 1
Cedarburg, WI 53012-9702

Phone

(262) 377-8350

Fax

(262) 377-8390

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Timothy John Provencher, PT

Title

President

Phone

(262) 377-8350

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Michael Ruppel

  • Physical Therapist
  • Fox Point, WI
  • NPI 1053334607
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1427195304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7269 STATE ROAD 60",
            "address_2": "SUITE 1",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530129702",
            "telephone_number": "262-377-8350",
            "fax_number": "262-377-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7269 STATE ROAD 60",
            "address_2": "SUITE 1",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530129702",
            "telephone_number": "262-377-8350",
            "fax_number": "262-377-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE CORNERS PHYSICAL THERAPY S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "PROVENCHER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-377-8350",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4146-024",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "1504-154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40302100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Extendicare Homes, Inc.
• Fairway Medical LLC
• Family Vision Center Inc
• Brianne Fechter
• Mary Ellen Fitts, MSW
• Emma Flottemesch
• FMG Lincoln Boulevard Wisconsin LLC
• Shari Forbes, LCSW
• Margaret Elizabeth French, OTR/L
• Fusion Physical Therapy and Wellness

• Speech-Language Pathologist in Cedarburg, WI
• Providers in Cedarburg, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.