Active NPI
Kyle Newcomb, MPT, CSCS
- Physical Therapist
- Fort Atkinson, WI
National Provider Identifier
1083977334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11160-24
- Practice address
- 1504 Madison Ave
Fort Atkinson, WI 53538-3100 - Phone
- (920) 563-9357
- Fax
- (920) 568-6545
- NPI assigned
- Jun 21, 2012
- Sex
- Male
- 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 | 11160-24 | WI | Primary |
Addresses
Primary practice location
1504 Madison Ave
Fort Atkinson, WI 53538-3100
Mailing address
1504 Madison Ave
Fort Atkinson, WI 53538-3100
Phone (920) 563-9357
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11160-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1083977334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1504 MADISON AVE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535383100",
"telephone_number": "920-563-9357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 MADISON AVE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535383100",
"telephone_number": "920-563-9357",
"fax_number": "920-568-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWCOMB",
"first_name": "KYLE",
"credential": "MPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-21",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "11160-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.