Provider Demographics
NPI:1982870325
Name:UMNUS, MEREDITH SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:SUE
Last Name:UMNUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:S
Other - Last Name:BAERBOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:N2950 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2655
Mailing Address - Country:US
Mailing Address - Phone:262-245-4980
Mailing Address - Fax:262-245-2248
Practice Address - Street 1:N2950 STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2655
Practice Address - Country:US
Practice Address - Phone:262-245-4980
Practice Address - Fax:262-245-2248
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4760-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40262200Medicaid
WI1982870325Medicaid