Individual provider Active NPI

Nicole Roenius, DPT

  • Physical Therapist
  • Greendale, WI
National Provider Identifier
1760902647
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13802 Issued in WI
Practice address
5404 W Loomis Rd
Greendale, WI 53129-1411
Phone
(414) 421-0088
Fax
(414) 421-2163
NPI assigned
Jun 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 13802 WI Primary

Addresses

Primary practice location

5404 W Loomis Rd
Greendale, WI 53129-1411

Mailing address

5404 W Loomis Rd
Greendale, WI 53129-1411
Phone (414) 421-0088

Other names 1

  • Nicole Roth Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250821004142 AZ Practitioner - Physical Therapist in Private Practice 2860992112

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1335 Stranssner Dr
Brentwood, MO 63144-1872

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Empowerme Rehabilitation, LLC Physical Therapist CurrentSince Aug 1, 2025 Accepting new patients
Empowerme Rehabilitation, LLC Physical Therapist CurrentSince Aug 1, 2025 Accepting new patients

Locations

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1760902647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 W LOOMIS RD",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531291411",
            "telephone_number": "414-421-0088",
            "fax_number": "414-421-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5404 W LOOMIS RD",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531291411",
            "telephone_number": "414-421-0088",
            "fax_number": "414-421-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROENIUS",
        "first_name": "NICOLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ROTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.