Active NPI
Michelle Therese Joyce Prudlow, P.T.
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1891734620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4781-024
- Practice address
- 2025 E Newport Ave
Milwaukee, WI 53211-2906 - Phone
- (414) 961-4172
- NPI assigned
- Jun 6, 2006
- 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 Therapist | 225100000X | 4781-024 | WI | Primary |
Addresses
Primary practice location
2025 E Newport Ave
Milwaukee, WI 53211-2906
Mailing address
1300 Mierow LN
Brookfield, WI 53045-7813
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 |
|---|---|---|---|
| 4781-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891734620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 MIEROW LN",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530457813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 E NEWPORT AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532112906",
"telephone_number": "414-961-4172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOYCE PRUDLOW",
"first_name": "MICHELLE",
"middle_name": "THERESE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4781-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.