Active NPI
Cassandra Jane Wildenberg, MPT
- Physical Therapist
- Appleton, WI
National Provider Identifier
1629290952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10755-024
- Practice address
- 2400 E Capitol Dr
Appleton, WI 54911-8728 - Phone
- (920) 831-5050
- Fax
- (920) 735-7648
- NPI assigned
- May 3, 2007
- 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 | 10755-024 | 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
1516 S Commercial St
Neenah, WI 54956-4802
Phone (920) 831-5050
Other practice location 2
600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone (920) 831-5050
Other practice location 3
W5282 Amy Ave
Appleton, WI 54915-7233
Phone (920) 831-5050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36131200 | 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 |
|---|---|---|---|
| 10755-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690329600000",
"number": "1629290952",
"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": "1516 S Commercial St",
"address_purpose": "LOCATION",
"city": "Neenah",
"state": "WI",
"postal_code": "549564802",
"country_code": "US",
"telephone_number": "920-831-5050",
"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",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "W5282 Amy Ave",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "549157233",
"country_code": "US",
"telephone_number": "920-831-5050",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILDENBERG",
"first_name": "CASSANDRA",
"middle_name": "JANE",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2023-07-26",
"certification_date": "2023-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "10755-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36131200",
"state": "WI"
}
],
"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 26, 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.