Active NPI
Amy Anderson, PT
- Physical Therapist
- De Pere, WI
National Provider Identifier
1710003587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2119-024
- Practice address
- 1142 Orlando Dr
De Pere, WI 54115-9484 - Phone
- (920) 339-0700
- Fax
- (920) 330-0278
- NPI assigned
- Mar 22, 2007
- Last updated
- Apr 14, 2008
- 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 Therapist | 225100000X | 2119-024 | WI | Primary |
Addresses
Primary practice location
1142 Orlando Dr
De Pere, WI 54115-9484
Mailing address
1127 Aldrin St
De Pere, WI 54115
Phone (920) 680-0284
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40278500 | Medicaid | WI |
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 |
|---|---|---|---|
| 2119-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208131200000",
"number": "1710003587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1127 ALDRIN ST",
"city": "DE PERE",
"state": "WI",
"postal_code": "54115",
"telephone_number": "920-680-0284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1142 ORLANDO DR",
"city": "DE PERE",
"state": "WI",
"postal_code": "541159484",
"telephone_number": "920-339-0700",
"fax_number": "920-330-0278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "AMY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2008-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "2119-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40278500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.