Randi Rose Fennig

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

314319 Issued in WI

Practice address

6263 N Green Bay Ave
Glendale, WI 53209-3823

Phone

(414) 351-0543

NPI assigned

Aug 17, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1831865302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10355 W PLUM TREE CIR APT 201",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302634",
            "telephone_number": "414-614-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6263 N GREEN BAY AVE",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093823",
            "telephone_number": "414-351-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNIG",
        "first_name": "RANDI",
        "middle_name": "ROSE",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "314319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST ASSISTANT",
            "identifier": "314319",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eyeguyz I, LTD. (Pearle Vision)
• Families of Hope
• Family Ties Prenatal Care LLC
• Sharon S Fedderly, PHD
• Benjamin H Fendrich, LCSW, CSAC
• Anthony Arlo Ferguson, MD
• Joanne Fetting, OTR
• Thomas A. Fiedler, DDS
• Katlynn Diana Finley
• Katherine Healy Vissers Finn, D.O.

• Physical Therapy Assistant in Glendale, WI
• Providers in Glendale, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.