Individual provider Active NPI

Nicholas Timothy Sawyer, MPT

  • Physical Therapist
  • Fort Atkinson, WI
National Provider Identifier
1669706388
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11156-24 Issued in WI
Practice address
1504 Madison Ave
Fort Atkinson, WI 53538-3100
Phone
(920) 563-9357
Fax
(920) 568-6545
NPI assigned
Sep 28, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11156-24 WI Primary

Addresses

Primary practice location

1504 Madison Ave
Fort Atkinson, WI 53538-3100

Mailing address

1504 Madison Ave
Fort Atkinson, WI 53538-3100
Phone (920) 563-9357

Other practice location 1

222 Wisconsin Dr Ste 3
Jefferson, WI 53549-1541
Phone (920) 674-7767

Other practice location 2

W173N10915 Bernies Way
Germantown, WI 53022-4043
Phone (262) 509-3346

Other practice location 3

W173N10915 Bernies Way
Germantown, WI 53022-4043
Phone (262) 509-3346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210721003148 WI Practitioner - Physical Therapist in Private Practice 3870996382 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11156-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Group Practice LLC Physical Therapist CurrentSince Jun 15, 2021 Accepting new patients
Aegis Group Practice LLC Physical Therapist CurrentSince Jun 15, 2021 Accepting new patients
Aegis Group Practice LLC Physical Therapist Current Accepting new patients

Locations

4933 Old Greenwood Rd
Fort Smith, AR 72903

111 Owen Rd
Monona, WI 53716
Phone (608) 441-9990

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1669706388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 MADISON AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383100",
            "telephone_number": "920-563-9357",
            "fax_number": "920-568-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 MADISON AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383100",
            "telephone_number": "920-563-9357",
            "fax_number": "920-568-6545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 Wisconsin Dr Ste 3",
            "address_purpose": "LOCATION",
            "city": "Jefferson",
            "state": "WI",
            "postal_code": "535491541",
            "country_code": "US",
            "telephone_number": "920-674-7767",
            "fax_number": "920-674-7823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "W173N10915 Bernies Way",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "WI",
            "postal_code": "530224043",
            "country_code": "US",
            "telephone_number": "262-509-3346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "W173N10915 Bernies Way",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "WI",
            "postal_code": "530224043",
            "country_code": "US",
            "telephone_number": "262-509-3346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAWYER",
        "first_name": "NICHOLAS",
        "middle_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-28",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11156-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.