Kallie A Wikman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60989646 Issued in WA

Practice address

100 E 33Rd St Ste 204
Vancouver, WA 98663

Phone

(360) 823-0138

NPI assigned

Jun 26, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Proactive LLCGroup PAC ID 7315218708, 53 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• New Proactive LLC

  • Physical Therapy Clinic/Center
  • Oregon City, OR
  • NPI 1396273199

  Physical Therapist, WA

  Medicare reassignment Care Compare group NPD
• Rancho Physical Therapy, Inc.

  • Physical Therapist
  • Pacific Palisades, CA
  • NPI 1417242454
  NPD (past)

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1083109755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 NE VILLAGE ST",
            "city": "FAIRVIEW",
            "state": "OR",
            "postal_code": "970243827",
            "telephone_number": "503-489-1174",
            "fax_number": "503-489-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 33RD ST STE 204",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98663",
            "telephone_number": "360-823-0138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3142 Vista Way Ste 101",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "CA",
            "postal_code": "920563627",
            "country_code": "US",
            "telephone_number": "760-630-2258",
            "fax_number": "760-630-5367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3142 Vista Way Ste 101",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "CA",
            "postal_code": "920563627",
            "country_code": "US",
            "telephone_number": "760-630-2258",
            "fax_number": "760-630-5367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIKMAN",
        "first_name": "KALLIE",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-26",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT294922",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60989646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT294922",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine E Wiggin, ND
• Megan Lynn Wiggins, LMHCA
• Corrina Wijma
• Jennafer R Wike
• Alana Mariah Wikkeling
• Kara M Wiksell, MA
• Thomas Wilbanks
• Brandon Michael Wilburn, DMD
• Danielle Renee Wilcox, BA
• Evelyn J Wilcox, C.R.N.A.

• Physical Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; 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.