Active NPI
Jennifer M Witczak, P.T.
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1487867412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5910-024
- Practice address
- 1301 W Canal St Ste 200
Milwaukee, WI 53233-2667 - Phone
- (844) 708-4819
- Fax
- (414) 645-8811
- NPI assigned
- May 7, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5910-024 | WI | Primary |
Addresses
Primary practice location
1301 W Canal St Ste 200
Milwaukee, WI 53233-2667
Mailing address
3602 S Logan Ave
Milwaukee, WI 53207
Phone (414) 517-0893
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 |
|---|---|---|---|
| 5910-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542585600000",
"number": "1487867412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3602 S LOGAN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53207",
"telephone_number": "414-517-0893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 W CANAL ST STE 200",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532332667",
"telephone_number": "844-708-4819",
"fax_number": "414-645-8811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITCZAK",
"first_name": "JENNIFER",
"middle_name": "M",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2018-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "5910-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.