Mary Gilsdorf, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3089-024 Issued in WI

Practice address

2801 South Webster Avenue
Green Bay, WI 54301

Phone

(920) 337-1122

Fax

(920) 964-0550

NPI assigned

Mar 21, 2007

Last updated

Nov 28, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary Brochtrup Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1518083815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1324",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543051324",
            "telephone_number": "920-337-1122",
            "fax_number": "920-964-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 SOUTH WEBSTER AVENUE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-337-1122",
            "fax_number": "920-964-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILSDORF",
        "first_name": "MARY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3089-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40174500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BROCHTRUP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julia Gilboy, RN
• Amanda Rose Gillespie, APNP, PMHNP-BC
• Neil Charles Gillespie, MD
• Shane M Gillespie, D.O.
• Bryan Gilow
• Conor Gilson
• Susan Gilson, PHARM D
• Matthew T Giltner, PT
• Lucas Gindl, DC
• Karen Ginnow, RPH

• Physical Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; 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.