Active NPI
Joel James Sabourin, DPT
- Physical Therapist
- Plymouth, WI
National Provider Identifier
1588096663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12393-24
- Practice address
- 916 E Clifford St
Plymouth, WI 53073-2468 - Phone
- (920) 893-4777
- NPI assigned
- Jul 31, 2013
- 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 | 12393-24 | WI | Primary |
Addresses
Primary practice location
916 E Clifford St
Plymouth, WI 53073-2468
Mailing address
620A Saint Paul St
Kiel, WI 53042-1044
Phone (920) 905-5622
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 |
|---|---|---|---|
| 12393-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375228800000",
"number": "1588096663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620A SAINT PAUL ST",
"city": "KIEL",
"state": "WI",
"postal_code": "530421044",
"telephone_number": "920-905-5622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "916 E CLIFFORD ST",
"city": "PLYMOUTH",
"state": "WI",
"postal_code": "530732468",
"telephone_number": "920-893-4777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SABOURIN",
"first_name": "JOEL",
"middle_name": "JAMES",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-31",
"last_updated": "2013-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "12393-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.