Jennifer B Alizadeh, PT
Individual provider Active NPI Physical Therapist · Fond Du Lac, WI
NPI 1942562152 · NPPES record last updated Oct 12, 2016
Key facts
- NPI
- 1942562152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12075-24 (WI)
- Practice address
- 597 Kingswood Ave
Fond Du Lac, WI 54935-6399 - Phone
- (920) 238-3032
- Fax
- (920) 238-3048
- NPI assigned
- Jun 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 18
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Froedtert Andthe Medical College of Wisconsin Community Physicians Inc
Practice addresses (Care Compare)
110 Lone Oak LN
Hartford, WI 53027-2600
Phone (262) 670-1800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121205000053 | WI | Practitioner - Physical Therapist in Private Practice | 4789836347 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12075-24 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Medical College of Wisconsin, Inc. | Physical Therapist | Current | Accepting new patients |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients | |
| Athletic and Therapeutic Institute of Milwaukee, LLC | Current |
Accepting new patients | |
| Sundance Rehabilitation LLC | Physical Therapist | Current |
Accepting new patients |
Locations
21700 Intertech Dr
Brookfield, WI 53045
Phone (262) 532-8300
W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060
110 Lone Oak Ln
Hartford, WI 53027
Phone (262) 670-1800
6109 Braun Rd
Mount Pleasant, WI 53403
Phone (262) 484-4724
2315 E Moreland Blvd
Waukesha, WI 53186
Phone (262) 532-5700
1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 12075-24 | WI | Yes |
Addresses
Primary practice location
597 Kingswood Ave
Fond Du Lac, WI 54935-6399
Mailing address
645 Elm Grove Rd
Apt 4
Elm Grove, WI 53122-2545
Phone (262) 492-9080
Other providers in Fond Du Lac, WI
- Agnesian Healthcare, Inc
- Agnesian Healthcare, Inc
- Kabir Ahmed
- Jennifer Ajide
- Alicia Hans LCSW
- Reem Aljamaan
- Allay Home and Hospice, Inc.
- Desirae Nichole Alsum
- Nicole L Amidon
- Anchor Point Home Health Services
All providers in Fond Du Lac, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.