Active NPI
Jill Melissa Paque, MPT
- Physical Therapist
- Greenfield, WI
National Provider Identifier
1902079288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6051-024
- Practice address
- 5700 W Layton Ave
Greenfield, WI 53220-4016 - Phone
- (414) 281-7200
- NPI assigned
- Apr 8, 2008
- Sex
- Female
- 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 | 6051-024 | WI | Primary |
Addresses
Primary practice location
5700 W Layton Ave
Greenfield, WI 53220-4016
Mailing address
5700 W Layton Ave
Greenfield, WI 53220-4016
Phone (414) 281-7200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40403300 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6051-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477353600000",
"number": "1902079288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 W LAYTON AVE",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532204016",
"telephone_number": "414-281-7200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5700 W LAYTON AVE",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532204016",
"telephone_number": "414-281-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAQUE",
"first_name": "JILL",
"middle_name": "MELISSA",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-08",
"last_updated": "2016-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "6051-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40403300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.