Active NPI
Linda Immel
- Physical Therapist
- Marinette, WI
National Provider Identifier
1639276397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1335-24
- Practice address
- 831 Pine Beach Rd
Marinette, WI 54143-4225 - Phone
- (715) 732-5796
- NPI assigned
- Sep 17, 2006
- 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 | 1335-24 | WI | Primary |
Addresses
Primary practice location
831 Pine Beach Rd
Marinette, WI 54143-4225
Mailing address
281 Roselawn Blvd
Green Bay, WI 54301-1303
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40013500 | 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 |
|---|---|---|---|
| 1335-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639276397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "281 ROSELAWN BLVD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543011303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "831 PINE BEACH RD",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541434225",
"telephone_number": "715-732-5796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMMEL",
"first_name": "LINDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "1335-24",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40013500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marinette, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.