Active NPI
Gwendolyn Cordray, PT
- Physical Therapist
- De Pere, WI
National Provider Identifier
1467813550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14083
- Practice address
- 200 S 9TH St
De Pere, WI 54115-1393 - Phone
- (920) 338-4146
- NPI assigned
- Mar 16, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT024442 | PA | |
| Physical Therapist | 225100000X | 14083 | WI | Primary |
Addresses
Primary practice location
200 S 9TH St
De Pere, WI 54115-1393
Mailing address
2027 Whistling Swan Cir
De Pere, WI 54115-8234
Phone (860) 967-8083
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT024442 | PA | MD | Physical Therapist |
| 14083 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RG-Rhinelander, Inc. | Past | Accepting new patients | |
| Bayada Home Health Care, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Rennes Health & Rehab Center - Rhinelander
- Skilled Nursing Facility
- Rhinelander, WI
- NPI 1407164312
-
- Home Health Agency
- Newtown Square, PA
- NPI 1497796544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552003200000",
"number": "1467813550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2027 WHISTLING SWAN CIR",
"city": "DE PERE",
"state": "WI",
"postal_code": "541158234",
"telephone_number": "860-967-8083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S 9TH ST",
"city": "DE PERE",
"state": "WI",
"postal_code": "541151393",
"telephone_number": "920-338-4146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDRAY",
"first_name": "GWENDOLYN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-16",
"last_updated": "2019-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT024442",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.