Individual provider Active NPI

David Michael Reybrock, MPT

  • Physical Therapist
  • Waupaca, WI
National Provider Identifier
1942462668
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9794024 Issued in WI
Practice address
800 Riverside Dr
Waupaca, WI 54981-1943
Phone
(715) 258-1053
NPI assigned
Jun 25, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 9794024 WI Primary

Addresses

Primary practice location

800 Riverside Dr
Waupaca, WI 54981-1943

Mailing address

800 Riverside Dr
Waupaca, WI 54981-1943
Phone (715) 258-1053

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121117000068 WI Practitioner - Physical Therapist in Private Practice 3577714799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2105 E Enterprise Ave
Suite 113
Appleton, WI 54913-7862
Phone (920) 991-2561

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9794024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Physical Therapy & Sports Medicine SC Physical Therapist CurrentSince Aug 15, 2012 Accepting new patients
Advanced Physical Therapy & Sports Medicine SC Physical Therapist CurrentSince Aug 15, 2012 Accepting new patients

Locations

2105 E Enterprise Ave
Ste 113
Appleton, WI 54913
Phone (920) 560-1083

2105 E Enterprise Ave
Appleton, WI 54913
Phone (920) 560-1000

1370 N Shawano St
Ste A
New London, WI 54961
Phone (920) 531-1100

2918 Post Rd
Stevens Point, WI 54481
Phone (715) 345-2126

102 Grand Seasons Dr
Ste 1
Waupaca, WI 54981
Phone (715) 942-2553

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": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214352000000",
    "number": "1942462668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811943",
            "telephone_number": "715-258-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811943",
            "telephone_number": "715-258-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYBROCK",
        "first_name": "DAVID",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "9794024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupaca, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.