Active NPI
Judith M Mehlos, PT
- Physical Therapist
- Baraboo, WI
National Provider Identifier
1720145402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3469024
- Practice address
- 707 14TH St
Baraboo, WI 53913-1539 - Phone
- (608) 356-1480
- Fax
- (608) 356-1446
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 3469024 | WI | Primary |
Addresses
Primary practice location
707 14TH St
Baraboo, WI 53913-1539
Mailing address
707 14TH St
Baraboo, WI 53913-1539
Phone (608) 356-1480
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40169100 | Medicaid | WI |
Other names 1
- Judith Brandhagen
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3469024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501027200000",
"number": "1720145402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 14TH ST",
"city": "BARABOO",
"state": "WI",
"postal_code": "539131539",
"telephone_number": "608-356-1480",
"fax_number": "608-356-1446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 14TH ST",
"city": "BARABOO",
"state": "WI",
"postal_code": "539131539",
"telephone_number": "608-356-1480",
"fax_number": "608-356-1446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEHLOS",
"first_name": "JUDITH",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2017-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "3469024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40169100",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JUDITH",
"last_name": "BRANDHAGEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.