Individual provider Active NPI

Kaitlin Eichman, DPT

  • Physical Therapist
  • Portage, WI
National Provider Identifier
1174878631
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11686-24 Issued in WI
Practice address
2817 New Pinery Rd
Portage, WI 53901-9240
Phone
(608) 589-5333
NPI assigned
Jul 19, 2012
Last updated
Aug 18, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

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 11686-24 WI Primary

Addresses

Primary practice location

2817 New Pinery Rd
Portage, WI 53901-9240

Mailing address

911 Gillette LN
Wisconsin Dells, WI 53965-8666
Phone (715) 209-0737

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150304001406 WI Practitioner - Physical Therapist in Private Practice 6103142419 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Savior Healthcare, Inc. CurrentSince Aug 13, 2013 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Aug 13, 2013 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Apr 10, 2024 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Apr 10, 2024 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

103 S Gibson St
Medford, WI 54451
Phone (715) 748-8112

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

N4390 Crossroads Clinic Rd
Oxford, WI 53952
Phone (608) 589-5181

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

619 Bridge St
Prentice, WI 54556
Phone (715) 428-2626

Organizations & group practices 5

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": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1174878631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 GILLETTE LN",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "539658666",
            "telephone_number": "715-209-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019240",
            "telephone_number": "608-589-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EICHMAN",
        "first_name": "KAITLIN",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11686-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.