NPIMap

Individual provider Active NPI

Michelle Kujawa, PT

  • Physical Therapist
  • New Baden, IL
National Provider Identifier
1932103348
Registry record updated Nov 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.015449 Issued in IL
Practice address
211 E Hanover St
New Baden, IL 62265-1811
Phone
(618) 588-4000
Fax
(618) 588-4800
NPI assigned
Jun 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11-03291 KS
Orthopedic Physical Therapist 2251X0800X
Physical Therapist 225100000X 070.015449 IL Primary

Addresses

Primary practice location

211 E Hanover St
New Baden, IL 62265-1811

Mailing address

2810 Frank Scott Pkwy W
Suite 824
Belleville, IL 62223-5007
Phone (618) 234-9705

Other identifiers 1

IdentifierTypeStateIssuer
P00751927OtherILMEDICARE RAILROAD GRP PTAN

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

LicenseStateTypeSpecialty
070.015449ILMDPhysical Therapist
11-03291KSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rebound Physical Therapy Inc. Physical Therapist PastSince Apr 1, 2005 Accepting new patients
Rebound Physical Therapy at Wood Valley Physical Therapist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257465600000",
    "number": "1932103348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 FRANK SCOTT PKWY W",
            "address_2": "SUITE 824",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235007",
            "telephone_number": "618-234-9705",
            "fax_number": "618-257-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E HANOVER ST",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651811",
            "telephone_number": "618-588-4000",
            "fax_number": "618-588-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUJAWA",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-13",
        "last_updated": "2009-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-03291",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.015449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GRP PTAN",
            "identifier": "P00751927",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Baden, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; 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.