Connie J Blackwell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1326-019 Issued in WI

Practice address

5219 88TH Ave
Kenosha, WI 53144-7468

Phone

(262) 653-0850

NPI assigned

Jan 8, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Tender Touch Therapy LLC

  • Physical Therapist
  • Kenosha, WI
  • NPI 1518026533
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1699823542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5616 42ND AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442530",
            "telephone_number": "262-764-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 88TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531447468",
            "telephone_number": "262-653-0850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "CONNIE",
        "middle_name": "J",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1326-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36122800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Birndorf, MD
• Elizabeth Bisciglia
• Ashvini Varadhi Biswas
• Lillian Bitters, PT, DPT
• Robert Bjork, MD
• Joseph Blando
• Tracy C Blauser
• Peter David Blochowicz, CRNA
• Joshua A Bloom, MD
• Nicole Bloomquist, OD

• Physical Therapy Assistant in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.