NPIMap

Organization Active NPI

Body Renovation Physical Therapy SC

  • Physical Therapist
  • Grafton, WI
National Provider Identifier
1871664243
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BODY RENOVATION PHYSICAL THERAPY SC
Practice address
2020 Cheyenne CT
Grafton, WI 53024-9368
Phone
(262) 375-1075
Fax
(262) 375-4975
NPI assigned
Nov 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Authorized official

Name
Mr. Richard D Wagner Jr., PT CSCS VCSNPI 1225103476
Title
Partner
Phone
(262) 375-1075

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2020 Cheyenne CT
Grafton, WI 53024-9368

Mailing address

2020 Cheyenne CT
Grafton, WI 53024-9368
Phone (262) 375-1075

Other names 1

  • Body Renovation Health Services SC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070425000088 WI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779688403 Receives reassigned benefits from 17 practitioners
Practice locations: Waukesha, WI; Whitefish Bay, WI; Wauwatosa, WI; Mequon, WI; Grafton, WI

National Provider Directory

National Provider Directory

Locations

10590 N Port Washington Rd
Mequon, WI 53092
Phone (262) 375-1075

20900 Swenson Dr
Ste 575
Waukesha, WI 53186
Phone (262) 373-9168

1510 Underwood Ave
Wauwatosa, WI 53213
Phone (262) 375-1075

530 N 108th Pl
Wauwatosa, WI 53226
Phone (414) 231-9640

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1871664243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 CHEYENNE CT",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249368",
            "telephone_number": "262-375-1075",
            "fax_number": "262-375-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 CHEYENNE CT",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249368",
            "telephone_number": "262-375-1075",
            "fax_number": "262-375-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODY RENOVATION PHYSICAL THERAPY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "262-375-1075",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT CSCS VCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Body Renovation Health Services SC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grafton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.