Luke Derek Casona Berdin, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14132-24 Issued in WI

Practice address

717 E Alfred St, Weyauwega, Wi 54983
Weyauwega, WI 54983

Phone

(920) 867-3121

NPI assigned

Oct 19, 2018

Last updated

Jan 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1962978700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 STONE RIDGE RD APT 57",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549818639",
            "telephone_number": "929-273-9321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 E ALFRED ST, WEYAUWEGA, WI 54983",
            "city": "WEYAUWEGA",
            "state": "WI",
            "postal_code": "54983",
            "telephone_number": "920-867-3121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 Churchill St",
            "address_purpose": "LOCATION",
            "city": "Waupaca",
            "state": "WI",
            "postal_code": "549812027",
            "country_code": "US",
            "telephone_number": "715-258-8131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERDIN",
        "first_name": "LUKE DEREK",
        "middle_name": "CASONA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-19",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14132-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Weyauwega, WI
• Providers in Weyauwega, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.