Active NPI
Pamela J Kikillus, PT, DSC
- Physical Therapist
- Puyallup, WA
National Provider Identifier
1063468585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00005876
- Practice address
- 8011 112TH Street CT E
Puyallup, WA 98373-7814 - Phone
- (253) 848-0662
- Fax
- (253) 848-8567
- NPI assigned
- May 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00005876 | WA | Primary |
Addresses
Primary practice location
8011 112TH Street CT E
Puyallup, WA 98373-7814
Mailing address
9315 Gravelly Lake Dr SW
Suite 203
Lakewood, WA 98499-1574
Phone (253) 581-5200
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 444955 | Other | WA | LABOR & INDUSTRIES |
| 8346983 | Medicaid | WA | |
| 9605LE | Other | WA | REGENCE BLUESHIELD |
| 8930578 | Other | WA | L&I CRIME VICTIMS PROG |
Other names 1
- Pamela J Leerar
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00005876 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063468585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9315 GRAVELLY LAKE DR SW",
"address_2": "SUITE 203",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984991574",
"telephone_number": "253-581-5200",
"fax_number": "253-581-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8011 112TH STREET CT E",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983737814",
"telephone_number": "253-848-0662",
"fax_number": "253-848-8567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIKILLUS",
"first_name": "PAMELA",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "PT, DSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00005876",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "444955",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8346983",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUESHIELD",
"identifier": "9605LE",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I CRIME VICTIMS PROG",
"identifier": "8930578",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PAMELA",
"last_name": "LEERAR",
"middle_name": "J",
"credential": "PT, DSC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.