Individual provider Active NPI

Adam B Klarkowski, PT

  • Physical Therapist
  • Manitowoc, WI
National Provider Identifier
1063485258
Registry record updated Sep 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5856 Issued in WI
Practice address
1212 Memorial Dr
Ste 1
Manitowoc, WI 54220-2247
Phone
(920) 652-9554
Fax
(920) 652-9556
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2014

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 5856 WI Primary

Addresses

Primary practice location

1212 Memorial Dr
Ste 1
Manitowoc, WI 54220-2247

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222

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

LicenseStateTypeSpecialty
5856WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates of Manitowoc LTD Past Accepting new patients
Aurora Health Care North, Inc. Physical Therapist Past Accepting new patients
Baycare Clinic LLP Past Accepting new patients
Advanced Orthopaedic Physical Therapy, LLC Physical Therapist PastSince Jan 1, 2011 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: adam.klarkowski.1@14940.direct.athenahealth.com

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410739200000",
    "number": "1063485258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2222",
            "fax_number": "630-759-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 MEMORIAL DR",
            "address_2": "STE 1",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202247",
            "telephone_number": "920-652-9554",
            "fax_number": "920-652-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLARKOWSKI",
        "first_name": "ADAM",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2014-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "5856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.