Active NPI
Shawn William Birkholz, PTA
- Physical Therapy Assistant
- Brookfield, WI
National Provider Identifier
1609606532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4192
- Practice address
- 13455 Kenmar CT
Brookfield, WI 53005-6536 - Phone
- (262) 424-0313
- NPI assigned
- Aug 5, 2024
- 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 Therapy Assistant | 225200000X | 4192 | WI | Primary |
Addresses
Primary practice location
13455 Kenmar CT
Brookfield, WI 53005-6536
Mailing address
13455 Kenmar CT
Brookfield, WI 53005-6536
Phone (262) 424-0313
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 |
|---|---|---|---|
| 4192 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1609606532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13455 KENMAR CT",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530056536",
"telephone_number": "262-424-0313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13455 KENMAR CT",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530056536",
"telephone_number": "262-424-0313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIRKHOLZ",
"first_name": "SHAWN",
"middle_name": "WILLIAM",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-05",
"last_updated": "2024-08-05",
"certification_date": "2024-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "4192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.