Individual provider Active NPI

John Christopher Kazalas, MPT,

  • Physical Therapist
  • Williamson, WV
National Provider Identifier
1124039243
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
002017 Issued in WV
Practice address
54 W 3Rd Ave
Williamson, WV 25661-3508
Phone
(304) 235-4300
Fax
(304) 235-0176
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 002017 WV Primary
Physical Therapist 225100000X PT013202L PA

Addresses

Primary practice location

54 W 3Rd Ave
Williamson, WV 25661-3508

Mailing address

PO Box 844
Williamson, WV 25661-0844
Phone (412) 779-1164

Other identifiers 2

IdentifierTypeStateIssuer
571136141002OtherWVBC/BS
3810000543MedicaidWV

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
PT013202LPAMDPhysical Therapist
002017WVMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124039243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256610844",
            "telephone_number": "412-779-1164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 W 3RD AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613508",
            "telephone_number": "304-235-4300",
            "fax_number": "304-235-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAZALAS",
        "first_name": "JOHN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "MPT,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "002017",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT013202L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "571136141002",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000543",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamson, WV

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.

Verify at the official NPI Registry.