Individual provider Active NPI

Jennifer L. Ballweg, DPT

  • Physical Therapist
  • Stoughton, WI
National Provider Identifier
1992013106
Registry record updated Sep 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11544-024 Issued in WI
Practice address
2300 US Hwy 51 138
Suite G
Stoughton, WI 53589-0000
Phone
(608) 873-2292
NPI assigned
Sep 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2010

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 11544-024 WI Primary

Addresses

Primary practice location

2300 US Hwy 51 138
Suite G
Stoughton, WI 53589-0000

Mailing address

900 Ridge St
Stoughton, WI 53589-1864
Phone (608) 873-2292

Other identifiers 1

IdentifierTypeStateIssuer
11544-024MedicaidWI

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11544-024WIMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1992013106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RIDGE ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891864",
            "telephone_number": "608-873-2292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 US HWY 51 138",
            "address_2": "SUITE G",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535890000",
            "telephone_number": "608-873-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLWEG",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11544-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11544-024",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoughton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; 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.