Active NPI
John A Emmerich II, P.T.A.
- Physical Therapy Assistant
- Monona, WI
National Provider Identifier
1710045505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 37019
- Practice address
- 6408 Copps Ave
Monona, WI 53716-3702 - Phone
- (608) 417-3131
- NPI assigned
- Dec 5, 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 Therapy Assistant | 225200000X | 37019 | WI | Primary |
Addresses
Primary practice location
6408 Copps Ave
Monona, WI 53716-3702
Mailing address
202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710045505 | 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 |
|---|---|---|---|
| 37019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1710045505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 S PARK ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537151507",
"telephone_number": "608-417-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6408 COPPS AVE",
"city": "MONONA",
"state": "WI",
"postal_code": "537163702",
"telephone_number": "608-417-3131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMMERICH",
"first_name": "JOHN",
"middle_name": "A",
"name_suffix": "II",
"credential": "P.T.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "37019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710045505",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.