Fusion Physical Therapy and Wellness

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

10888-24 Issued in WI

Legal business name

FUSION PHYSICAL THERAPY AND WELLNESS

Practice address

N49W6693 Western Rd
Cedarburg, WI 53012-1804

Phone

(414) 412-8072

NPI assigned

Dec 9, 2013

Organization subpart

No

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

Authorized official

Name

Kristin M Novak, DPT

Title

Docatorate Physical Therapy

Phone

(414) 412-8072

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386547200000",
    "number": "1700217205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 170826",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532178076",
            "telephone_number": "414-412-8072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N49W6693 WESTERN RD",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530121804",
            "telephone_number": "414-412-8072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUSION PHYSICAL THERAPY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2013-12-09",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DOCATORATE PHYSICAL THERAPY",
        "authorized_official_telephone_number": "414-412-8072",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WI",
            "license": "10888-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659565133",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Five Corners Physical Therapy S.C.
• Emma Flottemesch
• FMG Lincoln Boulevard Wisconsin LLC
• Shari Forbes, LCSW
• Margaret Elizabeth French, OTR/L
• Ilanna Rae Gabriel, LMT
• Genine Marie Ganado, OTR
• Daniel Carlos Garcia, D.D.S.
• Holly Jane Gardenier, MS, LPC, CSAC, ICS
• Marlyn K Gassert

• Physical Therapy Clinic/Center in Cedarburg, WI
• Providers in Cedarburg, WI by specialty
• Physical Therapy Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; 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.