Kaitlyn Rose Couillard, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3203 Issued in WI

Practice address

3117 Shore Dr
Marinette, WI 54143-4293

Phone

(715) 732-5111

NPI assigned

Nov 16, 2021

Last updated

Oct 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kaitlyn Rose Thill Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1174289938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3117 SHORE DR",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541434293",
            "telephone_number": "715-732-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUILLARD",
        "first_name": "KAITLYN",
        "middle_name": "ROSE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-16",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "3203",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502007910",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100191537",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "843324594",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kthill@adaptiverehab.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "501 2nd St",
            "city": "Menominee",
            "state": "MI",
            "country_code": "US",
            "postal_code": "498583203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "THILL",
            "middle_name": "ROSE",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Corgan Vision Clinic, S.C.
• Timothy Corgan, O.D.
• Cornerstone Caregiving East LLC
• Cornerstone Christian Counseling LLC
• Robin Corwin, APNP
• County of Marinette (Marinette County Health & Human Services)
• County of Marinette
• County of Marinette
• County of Marinette
• County of Marinette (Marinette County Health & Human Services)

• Physical Therapy Assistant in Marinette, WI
• Providers in Marinette, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.