Individual provider Active NPI

Jill Fraundorf, P.T.

  • Physical Therapist
  • Brookfield, WI
National Provider Identifier
1497901896
Registry record updated Aug 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4662-024 Issued in WI
Practice address
275 Regency CT
Suite 200
Brookfield, WI 53045-6168
Phone
(262) 798-9650
NPI assigned
Aug 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4662-024 WI Primary

Addresses

Primary practice location

275 Regency CT
Suite 200
Brookfield, WI 53045-6168

Mailing address

PO Box 611
Brookfield, WI 53008-0611
Phone (262) 798-9650

Other identifiers 1

IdentifierTypeStateIssuer
4662-024OtherWIPHYSICAL THERAPIST STATE LICENSE

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

LicenseStateTypeSpecialty
4662-024WIMDPhysical Therapist
4662WIMDAdvanced Practice Midwife

NPI Registry JSON

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219017600000",
    "number": "1497901896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 611",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530080611",
            "telephone_number": "262-798-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 REGENCY CT",
            "address_2": "SUITE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530456168",
            "telephone_number": "262-798-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAUNDORF",
        "first_name": "JILL",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2008-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4662-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST STATE LICENSE",
            "identifier": "4662-024",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.