Active NPI
Samantha Lyn Fetterer, PTA
- Physical Therapy Assistant
- Sheboygan, WI
National Provider Identifier
1740492404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 74-019
- Practice address
- 2629 N 7TH St
Sheboygan, WI 53083-4932 - Phone
- (920) 451-5550
- Fax
- (920) 451-5664
- NPI assigned
- May 4, 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 Therapy Assistant | 225200000X | 74-019 | WI | Primary |
Addresses
Primary practice location
2629 N 7TH St
Sheboygan, WI 53083-4932
Mailing address
2120 Broadway Avenue
Sheboygan, WI 53081
Phone (920) 803-8316
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40469600 | 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 |
|---|---|---|---|
| 74-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193702400000",
"number": "1740492404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 BROADWAY AVENUE",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "53081",
"telephone_number": "920-803-8316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2629 N 7TH ST",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "530834932",
"telephone_number": "920-451-5550",
"fax_number": "920-451-5664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERER",
"first_name": "SAMANTHA",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2007-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "74-019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40469600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheboygan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.