Active NPI
Jennifer Kay Gunderson, PT
- Pediatric Physical Therapist
- Mequon, WI
National Provider Identifier
1508904376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 10563-024
- Practice address
- 1486 West Mequon Rd
Mequon, WI 53092 - Phone
- (262) 241-8030
- Fax
- (262) 241-8304
- NPI assigned
- Feb 2, 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 10563-024 | WI | Primary |
Addresses
Primary practice location
1486 West Mequon Rd
Mequon, WI 53092
Mailing address
W64N332 Madison Ave
Cedarburg, WI 53012-2331
Phone (608) 469-4231
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 |
|---|---|---|---|
| 10563-024 | WI | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236556800000",
"number": "1508904376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W64N332 MADISON AVE",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530122331",
"telephone_number": "608-469-4231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1486 WEST MEQUON RD",
"city": "MEQUON",
"state": "WI",
"postal_code": "53092",
"telephone_number": "262-241-8030",
"fax_number": "262-241-8304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSON",
"first_name": "JENNIFER",
"middle_name": "KAY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-02",
"last_updated": "2009-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "WI",
"license": "10563-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.