Active NPI
Beth Marie Gundrum, P.T.
- Physical Therapist
- Muskego, WI
National Provider Identifier
1487985024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4872-024
- Practice address
- W166S7122 Still Meadow CT
Muskego, WI 53150-7404 - Phone
- (414) 422-4624
- NPI assigned
- Jan 21, 2010
- 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 | 4872-024 | WI | Primary |
Addresses
Primary practice location
W166S7122 Still Meadow CT
Muskego, WI 53150-7404
Mailing address
W166S7122 Still Meadow CT
Muskego, WI 53150-7404
Phone (414) 422-4624
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 |
|---|---|---|---|
| 4872-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264032000000",
"number": "1487985024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W166S7122 STILL MEADOW CT",
"city": "MUSKEGO",
"state": "WI",
"postal_code": "531507404",
"telephone_number": "414-422-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W166S7122 STILL MEADOW CT",
"city": "MUSKEGO",
"state": "WI",
"postal_code": "531507404",
"telephone_number": "414-422-4624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDRUM",
"first_name": "BETH",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-21",
"last_updated": "2010-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4872-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskego, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.