Prerna Brisky
Individual provider Active NPI Physical Therapist · Gordon, WI
NPI 1679971899 · NPPES record last updated Dec 6, 2018
Key facts
- NPI
- 1679971899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12930 (WI)
- Practice address
- 14624 S Whitefish Lake Rd
Gordon, WI 54838-9363 - Phone
- (954) 816-4150
- NPI assigned
- Dec 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advantage Physical Therapy and Sports Rehab, LLC
Practice addresses (Care Compare)
10405 Vermont Ave
Hayward, WI 54843-6111
Phone (715) 699-1355
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1247587 | TX | MD | Physical Therapist |
| 12930 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Physical Therapy & Sports Rehab, LLC | Past | Accepting new patients | |
| Advantage PT & Sports Rehab LLC | Past | Accepting new patients | |
| Medpro Healthcare Staffing | Past | Accepting new patients | |
| Advantage Physical Therapy & Sports Rehab, LLC | Past | Accepting new patients | |
| Advantage Physical Therapy & Sports Rehab, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1247587 | TX | |
| Physical Therapist | 225100000X | 12930 | WI | Yes |
Addresses
Primary practice location
14624 S Whitefish Lake Rd
Gordon, WI 54838-9363
Mailing address
14624 S Whitefish Lake Rd
Gordon, WI 54838-9363
Phone (715) 816-4150
Other practice location 1
1580 Sawgrass Corporate Pkwy
Suite 100
Sunrise, FL 33323-2859
Phone (954) 332-4445
Other names
- Prerna Delair
Other providers in Gordon, WI
All providers in Gordon, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.