Active NPI
Miranda Jo Wiegel, PTA
- Physical Therapy Assistant
- Sun Prairie, WI
National Provider Identifier
1790922110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1435-019
- Practice address
- 41 Rickel Rd
Sun Prairie, WI 53590-1840 - Phone
- (608) 837-8529
- NPI assigned
- Jan 8, 2009
- 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 | 1435-019 | WI | Primary |
Addresses
Primary practice location
41 Rickel Rd
Sun Prairie, WI 53590-1840
Mailing address
N9193 State Road 78
Blanchardville, WI 53516-9632
Phone (608) 558-2382
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 |
|---|---|---|---|
| 1435-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231372800000",
"number": "1790922110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N9193 STATE ROAD 78",
"city": "BLANCHARDVILLE",
"state": "WI",
"postal_code": "535169632",
"telephone_number": "608-558-2382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 RICKEL RD",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535901840",
"telephone_number": "608-837-8529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEGEL",
"first_name": "MIRANDA",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-08",
"last_updated": "2009-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "1435-019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sun Prairie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.