NPIMap

Individual provider Active NPI

Jessica Marie Wenzlaff, PT, DPT

  • Physical Therapist
  • Winona, MN
National Provider Identifier
1609333822
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11909 Issued in MN
Practice address
1512 W Service Dr
Winona, MN 55987-2540
Phone
(507) 474-6900
Fax
(507) 474-0502
NPI assigned
Feb 24, 2019
Last updated
Jan 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1314522 TX
Orthopedic Physical Therapist 2251X0800X 11909 MN
Physical Therapist 225100000X 11909 MN Primary

Addresses

Primary practice location

1512 W Service Dr
Winona, MN 55987-2540

Mailing address

1512 W Service Dr
Winona, MN 55987-2540
Phone (507) 474-6900

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL jess@sportnspine.com
Direct Messaging Address jess@sportnspine.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220316002619 MN Practitioner - Physical Therapist in Private Practice 3375884000 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sport & Spine Physical Therapy of Winona, Inc Physical Therapist CurrentSince Dec 8, 2021 Accepting new patients
Sport & Spine Physical Therapy of Winona, Inc CurrentSince Dec 8, 2021 Accepting new patients

Locations

1512 W Service Dr
Winona, MN 55987
Phone (507) 474-6900

Organizations & group practices 2

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": "1550966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1609333822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W SERVICE DR",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559872540",
            "telephone_number": "507-474-6900",
            "fax_number": "507-474-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 W SERVICE DR",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559872540",
            "telephone_number": "507-474-6900",
            "fax_number": "507-474-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENZLAFF",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-24",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1314522",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MN",
            "license": "11909",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "11909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jess@sportnspine.com",
            "affiliation": "N",
            "address_1": "1512 W Service Dr",
            "city": "Winona",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559872540",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jess@sportnspine.com",
            "affiliation": "N",
            "address_1": "1512 W Service Dr",
            "city": "Winona",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559872540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.