Active NPI
Tracie L Wuthrich, PTA
- Physical Therapy Assistant
- Madison, WI
National Provider Identifier
1699290668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2543-19
- Practice address
- 2620 Waunona Way
Madison, WI 53713 - Phone
- (608) 223-1452
- NPI assigned
- Aug 10, 2017
- 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 Therapy Assistant | 225200000X | 2543-19 | WI | Primary |
Addresses
Primary practice location
2620 Waunona Way
Madison, WI 53713
Mailing address
804 E 2ND Ave
Brodhead, WI 53520
Phone (608) 558-8818
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 |
|---|---|---|---|
| 2543-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502323200000",
"number": "1699290668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 E 2ND AVE",
"city": "BRODHEAD",
"state": "WI",
"postal_code": "53520",
"telephone_number": "608-558-8818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 WAUNONA WAY",
"city": "MADISON",
"state": "WI",
"postal_code": "53713",
"telephone_number": "608-223-1452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WUTHRICH",
"first_name": "TRACIE",
"middle_name": "L",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-10",
"last_updated": "2017-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "2543-19",
"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 Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.