Lakes Area Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4467024 Issued in WI

Legal business name

LAKES AREA PHYSICAL THERAPY, LLC

Practice address

800 Geneva Pkwy N
Suite 3
Lake Geneva, WI 53147-5701

Phone

(262) 248-9902

Fax

(262) 248-9419

NPI assigned

Nov 15, 2007

Last updated

Apr 7, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John R Van SusterenNPI 1619192150

Title

Physical Therapis / Owner

Phone

(262) 248-9902

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John R Van Susteren, PT

  • Physical Therapist
  • Lake Geneva, WI
  • NPI 1619192150
  Medicare reassignment NPD Authorized official
• Kim M. Cuculi, O.T.R.

  • Occupational Therapist
  • Lake Geneva, WI
  • NPI 1144259375
  NPD (past)
• Jean E Stephan, PT

  • Physical Therapist
  • Lake Geneva, WI
  • NPI 1730304205
  NPD (past)
• Denise Vavra, P.T.

  • Physical Therapist
  • Lake Geneva, WI
  • NPI 1770824856
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1588845804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 GENEVA PKWY N",
            "address_2": "SUITE 3",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531475701",
            "telephone_number": "262-248-9902",
            "fax_number": "262-248-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 GENEVA PKWY N",
            "address_2": "SUITE 3",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531475701",
            "telephone_number": "262-248-9902",
            "fax_number": "262-248-9419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES AREA PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "VAN SUSTEREN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICAL THERAPIS / OWNER",
        "authorized_official_telephone_number": "262-248-9902"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4467024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Geneva Dental Care LLC
• Lake Geneva Oral and Maxillofacial Surgery, LTD
• Lake Geneva Wellness Clinic LLC
• Lake Geneva-Genoa City Union High School District
• Lakes Area Counseling Clinic
• Lakes Counseling Center, LLC
• Andrew Nguyen Lam
• William Landry
• Lauren Lange, OT
• Mervin J Langley, LCSW

• Physical Therapist in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.