SANDRA RAE FONDOW (PT) – Physical Therapist, NPI 1083699664
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SANDRA RAE FONDOW (PT)
744 S Webster Ave
Green Bay, WI 543013505
Phone: (920) 433-7822
Fax: (920) 433-3651
Type: Location
1580 Commanche Ave
Green Bay, WI 543135751
Phone: (920) 435-8326
Type: Location
3263 Eaton Rd
Green Bay, WI 543116830
Phone: (920) 433-6700
Fax: (920) 043-3671
Type: Location
1800 Lawrence Dr
DE Pere, WI 541159108
Phone: (920) 983-3220
Fax: (920) 983-3226
Type: Location
725 S Webster Ave
Green Bay, WI 543013500
Phone: (920) 433-3655
Fax: (920) 433-3539
Type: Location
PO box, Russell Road, Paoli, Tredyffrin Township, Chester County, Pennsylvania, 19301, United States
GREEN BAY, WI 543052487
Phone: (920) 445-7222
Fax: (920) 445-7289
Type: Mailing
1630, Commanche Avenue, Ashwaubenon, Brown County, Wisconsin, 54313, United States
GREEN BAY, WI 543135753
Phone: (920) 430-4750
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-08-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050822001407 | I | Physical Therapist In Private Practice | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 54301)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WI | |
| - | WI | |
| Nurse Practitioner | WI | |
| Physical Therapist In Private Practice | WI | |
| - | WI | |
| - | WI | |
| O B S T E T R I C S/ G Y N E C O L O G Y | WI | |
| Nurse Practitioner | WA | |
| Certified Registered Nurse Anesthetist (Crna) | WI | |
| Physical Therapist In Private Practice | WI |
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