Active NPI
Jessica Marie Theroux, ATC, CSCS
- Athletic Trainer
- Appleton, WI
National Provider Identifier
1770631350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 465-039
- Practice address
- 2105 E Enterprise Ave
Suite 113
Appleton, WI 54913-7862 - Phone
- (920) 991-2561
- Fax
- (920) 991-2563
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 465-039 | WI | Primary |
Addresses
Primary practice location
2105 E Enterprise Ave
Suite 113
Appleton, WI 54913-7862
Mailing address
1605 Swan Rd
Apt 1
De Pere, WI 54115-8499
Phone (920) 265-0443
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 |
|---|---|---|---|
| 465-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770631350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1605 SWAN RD",
"address_2": "APT 1",
"city": "DE PERE",
"state": "WI",
"postal_code": "541158499",
"telephone_number": "920-265-0443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 E ENTERPRISE AVE",
"address_2": "SUITE 113",
"city": "APPLETON",
"state": "WI",
"postal_code": "549137862",
"telephone_number": "920-991-2561",
"fax_number": "920-991-2563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEROUX",
"first_name": "JESSICA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "ATC, CSCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "465-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.