Individual provider Active NPI

Kaitlyn Pacak, DPT

  • Physical Therapist
  • North Chesterfield, VA
National Provider Identifier
1053141978
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305216620 Issued in VA
Practice address
1115 Boulders Pkwy Ste 100B
North Chesterfield, VA 23225-4067
Phone
(804) 330-8165
Fax
(804) 330-3948
NPI assigned
Aug 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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 2305216620 VA Primary

Addresses

Primary practice location

1115 Boulders Pkwy Ste 100B
North Chesterfield, VA 23225-4067

Mailing address

PO Box 715868
Philadelphia, PA 19171-5868
Phone (804) 915-1910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241216001904 VA Practitioner - Physical Therapist in Private Practice 0941736805 Reassigns benefits to 2 organizations
I20251002004686 DC Practitioner - Physical Therapist in Private Practice 0941736805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthovirginia IncGroup PAC ID 0547157224, 570 clinicians
Fox Rehabilitation Services LLCGroup PAC ID 1355347410, 304 clinicians

Practice addresses (Care Compare)

1115 Boulders Pkwy
Suite 100B
North Chesterfield, VA 23225-4067
Phone (804) 915-1910

3925 Downs Dr
Chantilly, VA 20151-3308
Phone (703) 810-3992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orthovirginia, Inc. CurrentSince Aug 5, 2024 Accepting new patients
Orthovirginia, Inc CurrentSince Aug 5, 2024 Accepting new patients
Orthovirginia Inc Physical Therapist Current Accepting new patients
Fox Rehabilitation Services LLC Physical Therapist CurrentSince Sep 1, 2025 Accepting new patients

Locations

8200 Meadowbridge Rd
Ste 200
Mechanicsville, VA 23116
Phone (804) 560-5595

1115 Boulders Pkwy
Ste 200
North Chesterfield, VA 23225
Phone (804) 327-9242

1115 Boulders Pkwy
Ste 100B
North Chesterfield, VA 23225
Phone (804) 330-8165

20 E Piccadilly St
Ste 1114
Winchester, VA 22601

Organizations & group practices 4

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": "1722816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1053141978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 715868",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191715868",
            "telephone_number": "804-915-1910",
            "fax_number": "804-968-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 BOULDERS PKWY STE 100B",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232254067",
            "telephone_number": "804-330-8165",
            "fax_number": "804-330-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACAK",
        "first_name": "KAITLYN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305216620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; 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.