Active NPI
John Liddell, PHYSICAL THERAPIST
- Physical Therapist
- Mequon, WI
National Provider Identifier
1972969988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13065
- Practice address
- 1516 W Mequon Rd
Ste 201
Mequon, WI 53092-3264 - Phone
- (262) 241-8402
- Fax
- (262) 241-8403
- NPI assigned
- Jan 6, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11987 | AZ | |
| Physical Therapist | 225100000X | 10133 | MN | |
| Physical Therapist | 225100000X | 13065 | WI | Primary |
Addresses
Primary practice location
1516 W Mequon Rd
Ste 201
Mequon, WI 53092-3264
Mailing address
1516 W Mequon Rd
Ste 201
Mequon, WI 53092-3264
Phone (262) 241-8402
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 |
|---|---|---|---|
| 11987 | AZ | MD | Physical Therapist |
| 10133 | MN | MD | Physical Therapist |
| 13065 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462665600000",
"number": "1972969988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1516 W MEQUON RD",
"address_2": "STE 201",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923264",
"telephone_number": "262-241-8402",
"fax_number": "262-241-8403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1516 W MEQUON RD",
"address_2": "STE 201",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923264",
"telephone_number": "262-241-8402",
"fax_number": "262-241-8403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDELL",
"first_name": "JOHN",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-06",
"last_updated": "2016-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "11987",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "10133",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "13065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.