Active NPI
Benjamin Alan Gerloff, PT
- Physical Therapist
- Wild Rose, WI
National Provider Identifier
1861652166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9501-024
- Practice address
- 601 Grove Ave
Wild Rose, WI 54984-6903 - Phone
- (920) 622-5595
- Fax
- (920) 622-5594
- NPI assigned
- Jun 11, 2008
- Sex
- Male
- 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 Therapist | 225100000X | 9501-024 | WI | Primary |
Addresses
Primary practice location
601 Grove Ave
Wild Rose, WI 54984-6903
Mailing address
N4308 County Rd E
Pine River, WI 54965-7504
Phone (920) 229-0567
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 |
|---|---|---|---|
| 9501-024 | WI | MD | Physical Therapist |
Interoperability endpoints
- bgerloff119502@direct.thedacare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213142400000",
"number": "1861652166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N4308 COUNTY RD E",
"city": "PINE RIVER",
"state": "WI",
"postal_code": "549657504",
"telephone_number": "920-229-0567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 GROVE AVE",
"city": "WILD ROSE",
"state": "WI",
"postal_code": "549846903",
"telephone_number": "920-622-5595",
"fax_number": "920-622-5594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERLOFF",
"first_name": "BENJAMIN",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-11",
"last_updated": "2008-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "9501-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wild Rose, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.