Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theodore Azar

Individual provider Physical Therapist · NPI 1083303788

Theodore Azar is a Physical Therapist in Private Practice in Kenosha, Wisconsin. Qualified in 2022, 4 years ago. Practices with Athletico Ltd, a 2,186-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
4
Licensed in
WI
In the registry since
2023
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Practice location Address checks out

3535 30th Ave Ste 101
Kenosha, WI 53144-1632
Phone: (262) 657-7071
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 16267-24 (WI)

Record details

NPI number1083303788
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 8, 2023
Last updated in NPPESMay 8, 2023
Certification dateMay 3, 2023
Mailing address3535 30th Ave Ste 101, Kenosha, WI 53144-1632

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Kenosha