Active NPI
Tina Marie Ready, PTA
- Physical Therapy Assistant
- Shawano, WI
National Provider Identifier
1790949022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 199-19
- Practice address
- N 4231 Hwy 22 South
Shawano, WI 54166-4166 - Phone
- (715) 526-3158
- Fax
- (715) 526-6225
- NPI assigned
- Jul 16, 2008
- Last updated
- Apr 4, 2019
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 199-19 | WI | Primary |
Addresses
Primary practice location
N 4231 Hwy 22 South
Shawano, WI 54166-4166
Mailing address
N4231 Hwy 22 South
Shawano, WI 54166
Phone (715) 526-3158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40237400 | Medicaid | WI |
Other names 1
- Miss Tina Marie Vander Loop
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 |
|---|---|---|---|
| 199-19 | WI | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NSH Rib Lake LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554336000000",
"number": "1790949022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N4231 HWY 22 SOUTH",
"city": "SHAWANO",
"state": "WI",
"postal_code": "54166",
"telephone_number": "715-526-3158",
"fax_number": "715-526-6225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N 4231 HWY 22 SOUTH",
"city": "SHAWANO",
"state": "WI",
"postal_code": "541664166",
"telephone_number": "715-526-3158",
"fax_number": "715-526-6225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "READY",
"first_name": "TINA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-16",
"last_updated": "2019-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "199-19",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40237400",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TINA",
"last_name": "VANDER LOOP",
"middle_name": "MARIE",
"prefix": "MISS",
"credential": "PTA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shawano, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.