Individual provider Active NPI

Kelsi Midori-Joan Schiltz, DPT

  • Physical Therapist
  • Salem, OR
National Provider Identifier
1043626542
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
60633 Issued in OR
Practice address
3270 Liberty Rd S
Salem, OR 97302-4560
Phone
(503) 371-0779
Fax
(503) 371-0886
NPI assigned
Jul 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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 60633 OR Primary

Addresses

Primary practice location

3270 Liberty Rd S
Salem, OR 97302-4560

Mailing address

3270 Liberty Rd S
Salem, OR 97302-4560
Phone (503) 371-0779

Other names 1

  • Kelsi Midori-Joan Smith Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kschlitz329252@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190326002870 UT Practitioner - Physical Therapist in Private Practice 4183841463

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60633ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Metrodora ASC, LLC CurrentSince Aug 23, 2023 Accepting new patients

Locations

3535 S Market St
West Valley City, UT 84119
Phone (385) 430-1430

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1043626542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3270 LIBERTY RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024560",
            "telephone_number": "503-371-0779",
            "fax_number": "503-371-0886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 LIBERTY RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024560",
            "telephone_number": "503-371-0779",
            "fax_number": "503-371-0886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHILTZ",
        "first_name": "KELSI",
        "middle_name": "MIDORI-JOAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-03",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "60633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kschlitz329252@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELSI",
            "last_name": "SMITH",
            "middle_name": "MIDORI-JOAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.