Individual provider Active NPI

Kristen Jill Bruggeman, PT

  • Physical Therapist
  • Waco, TX
National Provider Identifier
1154658268
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1205070 Issued in TX
Practice address
6545 La Sol LN
Waco, TX 76712-4304
Phone
(574) 339-0941
NPI assigned
Nov 10, 2009
Last updated
Apr 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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 1205070 TX Primary

Addresses

Primary practice location

6545 La Sol LN
Waco, TX 76712-4304

Mailing address

6545 La Sol LN
Waco, TX 76712-4304
Phone (574) 339-0941

Other practice location 1

6040 Lute Rd
Portage, IN 46368-5008
Phone (219) 763-6858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250425000192 TX Practitioner - Physical Therapist in Private Practice 7911423611 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

60 Del Webb Blvd
The Hacienda at Georgetown
Georgetown, TX 78633-2488
Phone (737) 284-2807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Mar 4, 2025 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Mar 4, 2025 Accepting new patients
Great Lakes Senior Care, LLC Past Accepting new patients

Locations

300 Medical Pkwy
Lakeway, TX 78738
Phone (737) 263-0448

265 Plateau Dr
McKinney, TX 75069
Phone (512) 277-6405

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1257811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1154658268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 LA SOL LN",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767124304",
            "telephone_number": "574-339-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 LA SOL LN",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767124304",
            "telephone_number": "574-339-0941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6040 Lute Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685008",
            "country_code": "US",
            "telephone_number": "219-763-6858",
            "fax_number": "219-763-4858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUGGEMAN",
        "first_name": "KRISTEN",
        "middle_name": "JILL",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-10",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1205070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; 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.