Robyn Marie Formanek, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4284-024 Issued in WI

Practice address

257 W Saint George Ave
Grantsburg, WI 54840-7827

Phone

(715) 463-5353

NPI assigned

Mar 16, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: rformanek220062@excellian.direct.allina.com

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.

• St. Croix Regional Medical Center

  • Rural Health Clinic/Center
  • Webster, WI
  • NPI 1851652374
  NPD (past)

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1619946134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5585 GASLYN RD",
            "city": "WEBSTER",
            "state": "WI",
            "postal_code": "548939051",
            "telephone_number": "715-866-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMANEK",
        "first_name": "ROBYN",
        "middle_name": "MARIE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4284-024",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "4963",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40197300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melinda Alice Deye, APNP
• Daina Marie Duerr, RD, LD, CD
• Patricia Eid, NP
• Barbara Everson, RN
• Jenna Sue Fickbohm, L.P.N
• Jordan Fraser, DO
• Kathleen M French, PT
• Gary L Kaefer DDS SC
• Gretchen Jean Gerovac, NP
• Janelle R. Gomez, MSRDCD

• Physical Therapist in Grantsburg, WI
• Providers in Grantsburg, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.