Active NPI
Madelyn Plate, PT
- Physical Therapist
- Lake Geneva, WI
National Provider Identifier
1619717048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 16751-24
- Practice address
- 700 Geneva Pkwy N
Lake Geneva, WI 53147-4594 - Phone
- (262) 249-3505
- NPI assigned
- May 31, 2024
- Sex
- Female
- 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 | 16751-24 | WI | Primary |
Addresses
Primary practice location
700 Geneva Pkwy N
Lake Geneva, WI 53147-4594
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100278154 | Medicaid | WI |
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 |
|---|---|---|---|
| 16751-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720396800000",
"number": "1619717048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 735044",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606735044",
"telephone_number": "800-326-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 GENEVA PKWY N",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531474594",
"telephone_number": "262-249-3505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLATE",
"first_name": "MADELYN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-31",
"last_updated": "2024-07-08",
"certification_date": "2024-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "16751-24",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100278154",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Geneva, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.