Physically Correct Physical Therapy Services, LLC

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

5058-024 Issued in WI

Legal business name

PHYSICALLY CORRECT PHYSICAL THERAPY SERVICES, LLC

Practice address

5889 Riverside Dr
Greendale, WI 53129-2817

Phone

(414) 940-7278

Fax

(414) 235-4884

NPI assigned

May 21, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Philip William Bergold, PTNPI 1629073135

Title

Owner

Phone

(414) 940-7278

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Philip William Bergold, PT

  • Physical Therapist
  • Greendale, WI
  • NPI 1629073135
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369094400000",
    "number": "1710323563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370081",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532371181",
            "telephone_number": "414-940-7278",
            "fax_number": "414-235-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5889 RIVERSIDE DR",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531292817",
            "telephone_number": "414-940-7278",
            "fax_number": "414-235-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICALLY CORRECT PHYSICAL THERAPY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-21",
        "last_updated": "2013-05-21",
        "status": "A",
        "authorized_official_last_name": "BERGOLD",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-940-7278",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": "WI",
            "license": "5058-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Other Specialist/Technologist in Greendale, WI
• Providers in Greendale, WI by specialty
• Other Specialist/Technologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.