Individual provider Active NPI

Kyle J Sirek, PT

  • Physical Therapist
  • Wauwatosa, WI
National Provider Identifier
1578979514
Registry record updated Jul 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1273824 Issued in WI
Practice address
6810 W State St
Wauwatosa, WI 53213-2807
Phone
(414) 259-0623
NPI assigned
Jul 10, 2014
Last updated
Jul 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2014

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 1273824 WI Primary

Addresses

Primary practice location

6810 W State St
Wauwatosa, WI 53213-2807

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140806001019 WI Practitioner - Physical Therapist in Private Practice 8820215494 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1273824WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Jun 16, 2014 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Jun 16, 2014 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist Current Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

S74W16867 Janesville Rd
Muskego, WI 53150
Phone (262) 971-4200

6810 W State St
Wauwatosa, WI 53213
Phone (414) 259-0623

1224 Miller Park Way
West Milwaukee, WI 53214
Phone (414) 847-2971

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404950400000",
    "number": "1578979514",
    "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": "630-296-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 W STATE ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132807",
            "telephone_number": "414-259-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIREK",
        "first_name": "KYLE",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-10",
        "last_updated": "2014-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1273824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.