Active NPI
Anna Wissink, PTA
- Physical Therapy Assistant
- De Pere, WI
National Provider Identifier
1629327200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1930-19
- Practice address
- 200 S. Ninth St.
Rennes Health and Rehab Center,
De Pere, WI 54115 - Phone
- (920) 338-4145
- Fax
- (920) 338-9121
- NPI assigned
- Aug 29, 2012
- 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 Therapy Assistant | 225200000X | 1930-19 | WI | Primary |
Addresses
Primary practice location
200 S. Ninth St.
Rennes Health and Rehab Center,
De Pere, WI 54115
Mailing address
411 St. Mary'S Blvd
Green Bay, WI 54301
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 |
|---|---|---|---|
| 1930-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346198400000",
"number": "1629327200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 ST. MARY'S BLVD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "54301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S. NINTH ST.",
"address_2": "RENNES HEALTH AND REHAB CENTER,",
"city": "DE PERE",
"state": "WI",
"postal_code": "54115",
"telephone_number": "920-338-4145",
"fax_number": "920-338-9121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISSINK",
"first_name": "ANNA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-29",
"last_updated": "2012-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "1930-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.