Active NPI
Samantha Marie Wahner
- Physical Therapy Assistant
- Kenosha, WI
National Provider Identifier
1497682587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4350-19
- Practice address
- 6308 8TH Ave
Kenosha, WI 53143-5031 - Phone
- (126) 265-6390
- NPI assigned
- May 5, 2026
- 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 Therapy Assistant | 225200000X | 4350-19 | WI | Primary |
Addresses
Primary practice location
6308 8TH Ave
Kenosha, WI 53143-5031
Mailing address
6915 67TH St Unit 104
Kenosha, WI 53142-1477
Phone (414) 430-0308
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 |
|---|---|---|---|
| 4350-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777939200000",
"number": "1497682587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6915 67TH ST UNIT 104",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531421477",
"telephone_number": "414-430-0308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6308 8TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435031",
"telephone_number": "126-265-6390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHNER",
"first_name": "SAMANTHA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-05",
"last_updated": "2026-05-05",
"certification_date": "2026-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "4350-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.