Active NPI
Rene Rillorta, PT
- Specialist
- Kenosha, WI
National Provider Identifier
1932375466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 10208
- Practice address
- 3415 Sheridan Rd
Kenosha, WI 53140-1924 - Phone
- (262) 657-6681
- NPI assigned
- May 5, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 10208 | WI | Primary |
Addresses
Primary practice location
3415 Sheridan Rd
Kenosha, WI 53140-1924
Mailing address
3415 Sheridan Rd
Kenosha, WI 53140-1924
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40442900 | 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 |
|---|---|---|---|
| 10208 | WI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1932375466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3415 SHERIDAN RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531401924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3415 SHERIDAN RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531401924",
"telephone_number": "262-657-6681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILLORTA",
"first_name": "RENE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-05",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WI",
"license": "10208",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40442900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.