Individual provider Active NPI

Jennifer M. Palzewicz, PTA

  • Physical Therapy Assistant
  • Green Bay, WI
National Provider Identifier
1871004739
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
2589-19 Issued in WI
Practice address
1138 S Oneida St
Green Bay, WI 54304-2454
Phone
(715) 927-3578
NPI assigned
Oct 18, 2017
Reactivated
Dec 30, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2589-19 WI Primary

Addresses

Primary practice location

1138 S Oneida St
Green Bay, WI 54304-2454

Mailing address

1138 S Oneida St
Green Bay, WI 54304-2454

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

LicenseStateTypeSpecialty
2589-19WIMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1871004739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 S ONEIDA ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 S ONEIDA ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042454",
            "telephone_number": "715-927-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALZEWICZ",
        "first_name": "JENNIFER",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-18",
        "last_updated": "2025-12-30",
        "deactivation_date": "2018-05-04",
        "reactivation_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2589-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2025; 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.