Active NPI
Luke Pan, PT, DPT
- Physical Therapist
- Appleton, WI
National Provider Identifier
1619329083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13453-24
- Practice address
- 2400 E Capitol Dr
Appleton, WI 54911-8728 - Phone
- (920) 831-5050
- Fax
- (920) 735-7648
- NPI assigned
- Jul 8, 2016
- 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 | 13453-24 | WI | Primary |
Addresses
Primary practice location
2400 E Capitol Dr
Appleton, WI 54911-8728
Mailing address
2400 E Capitol Dr
Appleton, WI 54911-8728
Phone (920) 831-5050
Other practice location 1
W5282 Amy Ave
Appleton, WI 54915-7233
Phone (920) 831-5050
Other practice location 2
600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone (920) 831-5050
Other practice location 3
1516 S Commercial St
Neenah, WI 54956-4802
Phone (920) 831-5050
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 |
|---|---|---|---|
| 13453-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690502400000",
"number": "1619329083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 E CAPITOL DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549118728",
"telephone_number": "920-831-5050",
"fax_number": "920-735-7648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 E CAPITOL DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549118728",
"telephone_number": "920-831-5050",
"fax_number": "920-735-7648"
}
],
"practiceLocations": [
{
"address_1": "W5282 Amy Ave",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "549157233",
"country_code": "US",
"telephone_number": "920-831-5050",
"fax_number": "920-735-7648",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "600 N Westhaven Dr",
"address_purpose": "LOCATION",
"city": "Oshkosh",
"state": "WI",
"postal_code": "549046926",
"country_code": "US",
"telephone_number": "920-831-5050",
"fax_number": "920-735-7648",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1516 S Commercial St",
"address_purpose": "LOCATION",
"city": "Neenah",
"state": "WI",
"postal_code": "549564802",
"country_code": "US",
"telephone_number": "920-831-5050",
"fax_number": "920-735-7648",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAN",
"first_name": "LUKE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-08",
"last_updated": "2023-07-28",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "13453-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.