Active NPI
Mark J Neu, PT
- Physical Therapist
- Kenosha, WI
National Provider Identifier
1689696015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4727-024
- Practice address
- 5024 Green Bay Rd
Kenosha, WI 53144-1702 - Phone
- (262) 925-0200
- Fax
- (262) 925-8846
- NPI assigned
- Jul 24, 2006
- 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 | 4727-024 | WI | Primary |
Addresses
Primary practice location
5024 Green Bay Rd
Kenosha, WI 53144-1702
Mailing address
PO Box 081433
Racine, WI 53408-1433
Phone (262) 321-0240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40290600 | Medicaid | WI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | NA | Direct |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4727 | WI | MD | Public Health Dentist |
| 4727-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625788800000",
"number": "1689696015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 081433",
"city": "RACINE",
"state": "WI",
"postal_code": "534081433",
"telephone_number": "262-321-0240",
"fax_number": "262-321-0242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5024 GREEN BAY RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531441702",
"telephone_number": "262-925-0200",
"fax_number": "262-925-8846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEU",
"first_name": "MARK",
"middle_name": "J",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2021-07-09",
"certification_date": "2021-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4727-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40290600",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "NA",
"affiliation": "N",
"endpointDescription": "NA",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "5024 Green Bay Rd",
"city": "Kenosha",
"state": "WI",
"country_code": "US",
"postal_code": "531441702",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.