Active NPI
John Peter Maccanelli, PT
- Physical Therapist
- Mount Pleasant, WI
National Provider Identifier
1578799151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11220-24
- Practice address
- 5502 Washington Ave Ste 500
Mount Pleasant, WI 53406-4094 - Phone
- (262) 637-2470
- Fax
- (262) 637-2532
- NPI assigned
- Jun 9, 2009
- Sex
- Male
- 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 Therapist | 225100000X | 11220-24 | WI | Primary |
Addresses
Primary practice location
5502 Washington Ave Ste 500
Mount Pleasant, WI 53406-4094
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11220-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471651200000",
"number": "1578799151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223",
"fax_number": "630-759-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5502 WASHINGTON AVE STE 500",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534064094",
"telephone_number": "262-637-2470",
"fax_number": "262-637-2532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACCANELLI",
"first_name": "JOHN",
"middle_name": "PETER",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-09",
"last_updated": "2016-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "11220-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.