Active NPI
Brian A. Vetterkind, DPT
- Physical Therapist
- Grafton, WI
National Provider Identifier
1770838120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12017-24
- Practice address
- 2225 Wisconsin Ave Ste 100
Grafton, WI 53024 - Phone
- (262) 474-0063
- Fax
- (262) 222-6281
- NPI assigned
- Jul 20, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12017-24 | WI | Primary |
Addresses
Primary practice location
2225 Wisconsin Ave Ste 100
Grafton, WI 53024
Mailing address
600 Oakmont LN Ste 600C
Westmont, IL 60559-5548
Phone (630) 575-1980
Other practice location 1
5340 Washington Ave
Mount Pleasant, WI 53406-4229
Phone (262) 638-1272
Other practice location 2
5340 Washington Ave
Mount Pleasant, WI 53406-4229
Phone (262) 638-1272
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 859400077 | Other | WI | MEDICARE |
| WI2660001 | Other | WI | MEDICARE |
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 |
|---|---|---|---|
| 12017-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1770838120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 OAKMONT LN STE 600C",
"city": "WESTMONT",
"state": "IL",
"postal_code": "605595548",
"telephone_number": "630-575-1980",
"fax_number": "262-657-7190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2225 WISCONSIN AVE STE 100",
"city": "GRAFTON",
"state": "WI",
"postal_code": "53024",
"telephone_number": "262-474-0063",
"fax_number": "262-222-6281"
}
],
"practiceLocations": [
{
"address_1": "5340 Washington Ave",
"address_purpose": "LOCATION",
"city": "Mount Pleasant",
"state": "WI",
"postal_code": "534064229",
"country_code": "US",
"telephone_number": "262-638-1272",
"fax_number": "262-638-1287",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5340 Washington Ave",
"address_purpose": "LOCATION",
"city": "Mount Pleasant",
"state": "WI",
"postal_code": "534064229",
"country_code": "US",
"telephone_number": "262-638-1272",
"fax_number": "262-638-1287",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VETTERKIND",
"first_name": "BRIAN",
"middle_name": "A.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-20",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "12017-24",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "859400077",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "WI2660001",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grafton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.