Active NPI
Roxann Kay Nedrelo, P.T.
- Physical Therapist
- Black River Falls, WI
National Provider Identifier
1568638401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2455-024
- Practice address
- 1311 Tyler St
Black River Falls, WI 54615-1564 - Phone
- (715) 284-4396
- Fax
- (715) 284-9580
- NPI assigned
- Apr 30, 2008
- Last updated
- Apr 30, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2455-024 | WI | Primary |
| Physical Therapist | 225100000X | 4377 | MN |
Addresses
Primary practice location
1311 Tyler St
Black River Falls, WI 54615-1564
Mailing address
1311 Tyler St
Black River Falls, WI 54615-1564
Phone (715) 284-4396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40116900 | Medicaid | WI |
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 |
|---|---|---|---|
| 4377 | MN | MD | Marriage & Family Therapist |
| 2455-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1568638401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 TYLER ST",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546151564",
"telephone_number": "715-284-4396",
"fax_number": "715-284-9580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 TYLER ST",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546151564",
"telephone_number": "715-284-4396",
"fax_number": "715-284-9580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEDRELO",
"first_name": "ROXANN",
"middle_name": "KAY",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-30",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "2455-024",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "4377",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40116900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Black River Falls, WI
- Paige Mogg
- Lori Jean Mohring, MS, LPC, SAC
- Lindsay Marie Morgan, M.S. CF-SLP
- Shawn R Nadeau, RN, BSN
- Ashley Napiwocki, PHARMD
- Michael Ray Newby, PHYSICAL THERAPIST
- Mary Clare Nordahl, CRNA
- Northland Hearing Centers, Inc. (Better Hearing Centre)
- Northwest Journey - Black River Falls
- Shelby M Nykiel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.