Individual provider Active NPI

Kaileigh Dietrich-Denton, PT

  • Physical Therapist
  • Lake Oswego, OR
National Provider Identifier
1053102178
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
65699 Issued in OR
Practice address
4859 Meadows Rd Ste 161
Lake Oswego, OR 97035-2628
Phone
(503) 387-6081
NPI assigned
May 16, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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 65699 OR Primary

Addresses

Primary practice location

4859 Meadows Rd Ste 161
Lake Oswego, OR 97035-2628

Mailing address

625 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2395

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250603000661 OR Practitioner - Physical Therapist in Private Practice 7416466339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapydia IncGroup PAC ID 2264678226, 35 clinicians

Practice addresses (Care Compare)

4859 Meadows Rd
Suite 161
Lake Oswego, OR 97035-2628
Phone (503) 387-6081

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Therapydia, Inc. Physical Therapist CurrentSince Jun 2, 2025 Accepting new patients
Therapydia, Inc. Physical Therapist CurrentSince Jun 2, 2025 Accepting new patients

Locations

625 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546

4859 Meadows Rd
Ste 161
Lake Oswego, OR 97035
Phone (503) 387-6081

2808 E Burnside St
Portland, OR 97214
Phone (503) 477-4802

3838 SE Powell Blvd
Portland, OR 97202
Phone (503) 603-4555

4140 N Williams Ave
Portland, OR 97217
Phone (971) 318-1367

Organizations & group practices 2

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": "1747353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1053102178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 KENMOOR AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4859 MEADOWS RD STE 161",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352628",
            "telephone_number": "503-387-6081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH-DENTON",
        "first_name": "KAILEIGH",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-16",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.