Active NPI
Jack Ryan Cervantes, PT, DPT
- Physical Therapist
- Madison, WI
National Provider Identifier
1659002038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15811-24
- Practice address
- 621 Science Dr
Madison, WI 53711-1074 - Phone
- (608) 265-3341
- NPI assigned
- Jun 17, 2022
- Sex
- Male
- 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 | 15811-24 | WI | Primary |
Addresses
Primary practice location
621 Science Dr
Madison, WI 53711-1074
Mailing address
2617 E Johnson St Apt L
Madison, WI 53704-5061
Phone (708) 307-2799
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 |
|---|---|---|---|
| 15811-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655424000000",
"number": "1659002038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2617 E JOHNSON ST APT L",
"city": "MADISON",
"state": "WI",
"postal_code": "537045061",
"telephone_number": "708-307-2799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 SCIENCE DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537111074",
"telephone_number": "608-265-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERVANTES",
"first_name": "JACK",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-17",
"last_updated": "2022-06-17",
"certification_date": "2022-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "15811-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.